ZOLEDRONIC ACID THERAPY OF PATIENTS WITH PAGET DISEASE OF BONE RESISTANT TO OR WITH UNSUSTAINED REMISSION FOLLOWING PRIOR BISPHOSPHONATE THERAPY.

Abstract

OBJECTIVE:

To evaluate the effect of zoledronic acid (ZA) in patients with Paget disease (PD) who had not had a biochemical remission with prior bisphosphonate therapy or had a remission ≤12 months.

METHODS:

The effects of ZA therapy were studied in 14 patients aged 54 to 90. Serum alkaline phosphatase (ALP) levels were elevated to at least 40% above the normal reference range, and glomerular filtration rates (GFRs) were ≥40 mL/minute. ZA (5 mg) was infused over 15 minutes. ALP and urine N-telopeptide/creatinine (NTx/Cr) were obtained before therapy and at 3, 6, 9, and 12 months, and thereafter at 4-month intervals.

RESULTS:

At baseline, ALP ranged from 141 to 1,009 U/L. In 13 patients, ALP fell to normal following ZA administration. Remissions occurred in 9 patients who had not previously had a remission. Remissions varied from 12 to 60 months and were more prolonged in 4 patients with prior remissions ≤12 months. ZA failed to induce a remission in 1 patient. Ten to 12 days after therapy in 3 asymptomatic patients, serum calcium levels fell to 7.9, 8, and 8.3 mg/dL. Other than flu-like symptoms in 3 patients after ZA infusion, there were no other adverse effects.

CONCLUSION:

Therapy with ZA induced remissions in 13/14 patients and induced more prolonged remissions in patients who previously had remissions ≤12 months. The lack of remission in 1 patient despite 2 courses of therapy is evidence of a continuing therapeutic challenge for some patients with a more resistant form of PD.

• Authors: Joseph R Tucci
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 21 Issue 10 Pg. 1111-6 (Oct 2015) ISSN: 1530-891X [Print] United States
• PMID: 26151420 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Bone Density Conservation Agents
• Diphosphonates
• Imidazoles
• Zoledronic Acid

Topics

• Aged
• Aged, 80 and over
• Bone Density Conservation Agents (therapeutic use)
• Diphosphonates (therapeutic use)
• Drug Resistance
• Female
• Humans
• Imidazoles (therapeutic use)
• Male
• Middle Aged
• Osteitis Deformans (drug therapy)
• Remission Induction
• Treatment Failure
• Zoledronic Acid