Pamidronate is superior to ibandronate in decreasing bone resorption, interleukin-6 and beta 2-microglobulin in multiple myeloma.

Abstract

OBJECTIVES:

Bisphosphonates have been found to reduce skeletal events in patients with multiple myeloma (MM). This is the first randomised trial to compare the efficacy of pamidronate and ibandronate, a third-generation aminobisphosphonate, in bone turnover and disease activity in MM patients.

METHODS:

Patients with MM, stage II or III, were randomly assigned to receive either pamidronate 90 mg (group I: 23 patients) or ibandronate 4 mg (group II: 21 patients) as a monthly intravenous infusion in addition to conventional chemotherapy. Skeletal events, such as pathologic fractures, hypercalcaemia, and bone radiotherapy were analysed. Bone resorption markers [N-terminal cross-linking telopeptide of type-I collagen (NTX) and tartrate-resistant acid phosphatase type 5b (TRACP-5b)], bone formation markers (bone alkaline phosphatase and osteocalcin), markers of disease activity (paraprotein, CRP, beta 2-microglobulin), and interleukin-6 (IL-6) were also studied.

RESULTS:

In both groups, the combination of chemotherapy with either pamidronate or ibandronate produced a reduction in bone resorption and tumour burden as measured by NTX, IL-6, paraprotein, CRP, and beta 2-microglobulin from the second month of treatment, having no effect on bone formation. TRACP-5b also had a significant reduction in the pamidronate group from the second month of treatment and in the ibandronate group from the sixth month. However, there was a greater reduction of NTX, IL-6, and beta 2-microglobulin in group I than in group II, starting at the second month of treatment (P = 0.002, 0.001, and 0.004, respectively) and of TRACP-5b, starting at the fourth month (P = 0.014), that being continued throughout the 10-month follow-up of this study. There was no difference in skeletal events during this period. A significant correlation was observed between changes of NTX and changes of TRACP-5b, IL-6, and beta 2-microglobulin from the second month for patients of both groups.

CONCLUSIONS:

These results suggest that a monthly dose of 90 mg of pamidronate is more effective than 4 mg of ibandronate in reducing osteoclast activity, bone resorption, IL-6, and possibly tumour burden in MM. TRACP-5b has also proved to be a useful new marker for monitoring bisphosphonates treatment in MM.

• Authors: Evangelos Terpos, Nora Viniou, Josu de la Fuente, John Meletis, Ersi Voskaridou, Christos Karkantaris, George Vaiopoulos, John Palermos, Xenophon Yataganas, John M Goldman, Amin Rahemtulla
• Journal: European journal of haematology (Eur J Haematol) Vol. 70 Issue 1 Pg. 34-42 (Jan 2003) ISSN: 0902-4441 [Print] England
• PMID: 12631257 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Antineoplastic Agents
• Biomarkers
• Collagen Type I
• Diphosphonates
• Interleukin-6
• Isoenzymes
• Peptides
• beta 2-Microglobulin
• collagen type I trimeric cross-linked peptide
• Collagen
• ACP5 protein, human
• Acid Phosphatase
• Tartrate-Resistant Acid Phosphatase
• Pamidronate
• Ibandronic Acid

Topics

• Acid Phosphatase (blood)
• Aged
• Antineoplastic Agents (administration & dosage)
• Biomarkers (blood, urine)
• Bone Resorption (drug therapy, etiology, prevention & control)
• Collagen (urine)
• Collagen Type I
• Diphosphonates (administration & dosage)
• Female
• Humans
• Ibandronic Acid
• Interleukin-6 (blood)
• Isoenzymes (blood)
• Male
• Middle Aged
• Multiple Myeloma (complications, drug therapy)
• Osteogenesis (drug effects)
• Pamidronate
• Peptides (urine)
• Tartrate-Resistant Acid Phosphatase
• beta 2-Microglobulin (blood)