Patients with multiple myeloma experienced fewer pathological vertebral fractures, skeletal-related events and pain when administered bisphosphonates, according to an updated review of 20 bisphosphonate trials published in The Cochrane Library.
“While we found no direct effect of bisphosphonates on overall survival compared with placebo or no treatment, there was statistically significant heterogeneity for the outcome of overall survival among the included randomized controlled trials,” researchers wrote.
Ambuj Kumar, MD, researcher in the Center for Evidence-Based Medicine and Health Outcomes Research at the University of South Florida, and colleagues aimed to assess the evidence related to the risks and benefits associated with amino bisphosphonates vs. non-amino bisphosphonates to manage patients with multiple myeloma.
The review included 20 trials consisting of 6,692 patients. The primary objective was to determine whether adding bisphosphonates to standard therapy in patients with multiple myeloma improved overall survival and progression-free survival while decreasing skeletal-related morbidity.
Of 12 clinical trials with an enrollment of 2,292 patients, no improvement in overall survival regarding overall mortality was found with the use of bisphosphonates compared with placebo or no treatment (HR=0.96; 95% CI, 0.82-1.13).
In seven trials with 1,116 patients, data demonstrated significant improvements in reduced vertebral fractures with the use of bisphosphonates compared with placebo or no treatment, according to the review (RR=0.74; 95% CI, 0.62-0.89).
The second goal of the review was to determine the actual effects of bisphosphonates on pain, quality of life, incidence of hypercalcemia, incidence of bisphosphonate-related gastrointestinal toxicities, osteonecrosis of the jaw and hypocalcaemia, they said.
Data from seven trials with 1,497 patients showed significant improvements in reducing skeletal-related events (RR=0.8; 95% CI, 0.72-0.89). Bisphosphonates were found to improve pain after researchers studied data from eight trials that included 1,281 patients (RR=0.75; 95% CI, 0.60-0.95).
Although significant adverse events were not identified, Kumar and colleagues said their work calls for a randomized clinical trial with a head-to-head comparison of zoledronate (Zometa, Novartis) and pamidronate (Aredia, Novartis) for their efficacy and safety in patients with multiple myeloma. Quality of life and cost-effectiveness should also be considered in future studies, they wrote.
Disclosure: The researchers report no relevant financial disclosures.