Characterization and incidence on acute phase reaction in Paget's disease after zoledronic acid infusion

2013 ◽  
Author(s):  
A Conesa Mateos ◽  
D Rotes Sala ◽  
J Carbonell Abello
Keyword(s):  
Zoledronic Acid ◽  
Acute Phase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Acute Phase Reaction ◽  
Phase Reaction ◽  
Acid Infusion

Preventive Role of Vitamin D Supplementation for Acute Phase Reaction after Bisphosphonate Infusion in Paget’s Disease

2019 ◽  
Vol 105 (3) ◽  
pp. e466-e476 ◽  
Author(s):  
Daniela Merlotti ◽  
Domenico Rendina ◽  
Riccardo Muscariello ◽  
Tommaso Picchioni ◽  
Mario Alessandri ◽  
...  
Keyword(s):  
Vitamin D ◽  
Acute Phase ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Vitamin D Supplementation ◽  
Acute Phase Reaction ◽  
Phase Reaction ◽  
Interventional Study ◽  
Hydroxyvitamin D ◽  
Previously Treated

Abstract Context Intravenous aminobisphosphonates (N-BPs) can induce an acute phase reaction (APR) in up to 40% to 70% of first infusions, causing discomfort and often requiring intervention with analgesics or antipyretics. Objective Our aim was to explore the risk factors of APR in a large sample of patients with Paget’s disease of bone (PDB) and to assess the possible preventive effects of vitamin D administration. Methods An observational analysis was performed in 330 patients with PDB at the time of N-BP infusion. Then, an interventional study was performed in 66 patients with active, untreated PDB to evaluate if vitamin D administration (oral cholecalciferol 50 000 IU/weekly for 8 weeks before infusion) may prevent APR. Results In a retrospective study, APR occurred in 47.6% and 18.3% of naive or previously treated patients, respectively. Its prevalence progressively increased in relation to the severity of vitamin D deficiency, reaching 80.0% in patients with 25-hydroxyvitamin D (25OHD) levels below 10 ng/mL (relative risk (RR) = 3.7; 95% confidence interval (CI) 2.8–4.7, P < .0001), even in cases previously treated with N-BPs. Moreover, APR occurred more frequently in patients who experienced a previous APR (RR = 2.8; 95% CI 1.5–5.2; P < .001) or in carriers of SQSTM1 mutation (RR = 2.3; 95% CI 1.3–4.2; P = .005). In the interventional study, vitamin D supplementation prevented APR in most cases, equivalent to a RR of 0.31 (95% CI 0.14–0.67; P < .005) with respect to prevalence rates of the observational cohort. A similar trend was observed concerning the occurrence of hypocalcemia. Conclusions The achievement of adequate 25OHD levels is recommended before N-BP infusion in order to minimize the risk of APR or hypocalcemia in PDB.

scholarly journals Adherence to and persistence with zoledronic acid treatment for osteoporosis—reasons for early discontinuation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Anna Spångeus ◽  
Simon Johansson ◽  
Mischa Woisetschläger
Keyword(s):  
Zoledronic Acid ◽  
Acute Phase ◽  
Acute Phase Reaction ◽  
University Hospital ◽  
Common Reason ◽  
Biological Aging ◽  
Phase Reaction ◽  
Treatment Termination ◽  
Lost To Follow Up

Abstract Summary This retrospective study reports 81% long-term (> 3 years) adherence to and 77% persistence with zoledronic acid (ZA) treatment in osteoporosis patients, with ZA being costfree for patients. Eight percent of patients discontinued treatment because of adverse events (AEs), with a tendency of higher discontinuation rate in older patients. Purpose This study investigated (1) long-term adherence to and persistence with ZA treatment in a real-world setting, (2) extent to which an adverse reaction to ZA impacted on adherence and persistence, and (3) whether there were sex or age differences in patients that had early treatment termination (ETT) due to AEs and those who adhered to the regimen. Methods All patients treated with ZA at the Endocrinology Department at Linköping University Hospital, Linköping, Sweden between 2012 and 2017 were included. ETT was defined as < 3 ZA infusions, which was confirmed from patients’ medical records. Results A total of 414 patients were treated with ZA, with 81% receiving > 3 ZA infusions. Three-year persistence was 77% for a treatment window of 365 days ± 90 days (75% with 365 days ± 60 days window). The most common reason for ETT was AEs (8%), followed by medical conditions (5%), biological aging (3%), and other (e.g., lost to follow-up [3%]). Most patients who discontinued treatment because of AEs reported symptoms of acute-phase reaction, and tended to be older than those who adhered to treatment (74 ± 9 vs 70 ± 13 years, p = 0.064). There was no difference in sex ratio between the 2 groups (85% vs 90% females, p = 0.367). Conclusion Rates of long-term adherence to and persistence with ZA treatment were high with a pre-scheduled 3-year treatment regimen in the tax-financed Swedish healthcare system. AEs—mainly acute-phase reaction—were the most common reason for ETT, occurring in nearly 1 out of 10 patients.

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