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Bisphosphonates Cut Skeletal Morbidity in Multiple Myeloma

No improvement in overall survival, although zoledronate superior to placebo or etidronate

THURSDAY, May 17 (HealthDay News) -- For patients with multiple myeloma, bisphosphonate treatment is associated with reduced pathological vertebral fractures, skeletal related events (SREs), and pain, but bisphosphonates do not appear to improve overall survival (OS), with the exception of zoledronate, which has been found to be superior to placebo and etidronate for improving OS, according to a review and meta-analysis published online May 16 in the The Cochrane Library.

Rahul Mhaskar, M.D., M.P.H., of the University of South Florida in Tampa, and colleagues updated a systematic review and meta-analysis to investigate the role of bisphosphonates on OS, progression-free survival, and skeletal-related morbidity in multiple myeloma. Twenty randomized controlled trials involving 6,692 patients with multiple myeloma were included.

The researchers found that, compared with placebo or no treatment, bisphosphonates had no direct effect on overall survival, although there was significant heterogeneity between the trials, which was explained by an OS benefit with zoledronate (P = 0.058). OS was improved with zoledronate versus etidronate (hazard ratio, 0.43) and placebo (hazard ratio, 0.61), but there were no significant differences between zoledronate and other bisphosphonates. Bisphosphonates were beneficial for prevention of pathological vertebral fractures (relative risk [RR], 0.74), SREs (RR, 0.80), and amelioration of pain (RR, 0.75) versus placebo or no treatment. There was no difference in incidence of osteonecrosis of the jaw between bisphosphonates. The use of bisphosphonates was not associated with increased frequency of gastrointestinal symptoms or hypocalcemia.

"Use of bisphosphonates in patients with multiple myeloma reduces pathological vertebral fractures, SREs, and pain," the authors write. "Zoledronate appears to be superior to placebo and etidronate in improving OS."

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