Treatment of multiple myeloma bone disease: experimental and clinical data
Yvonne Mary Papamerkouriou1, Eustathios Kenanidis, Zakareya Gamie
1Aristotle University Medical School, "PapaGeorgiou" General Hospital, Academic Orthopaedic Unit , Thessaloniki , Greece etsiridis@doctors.org.uk.
Introduction:
Bone disease is present in the majority of patients with multiple myeloma and can seriously affect quality of life and survival rate. In addition to suppression of osteoclastogenesis, there have been developments made in terms of the therapeutic agents available, such as novel immunomodulating agents, proteasome and receptor activator of nuclear factor κB ligand inhibitors.
Areas Covered:
AREAS COVERED include in vitro, in vivo and clinical evidence was collected using MEDLINE (1950 - May 2014), EMBASE (1980 - May 2014) and Google Scholar (1980 - May 2014) databases.
Expert Opinion:
Bisphosphonates are the mainstay of myeloma bone disease treatment. Oral clodronate and intravenous pamidronate and zoledronic acid are currently used drugs and seem to have comparable results in preventing skeletal-related events of the disease. Zoledronate can also have survival benefits and based on the available evidence is the superior bisphosphonate; however, its side effects have to be monitored. Denosumab had comparable results with zoledronate on myeloma bone disease treatment; its use has not been completely proven yet. There is an expanding set of drugs, proteasome inhibitors, under investigation with great potential to reduce the negative effects of myeloma cells on bone. Future clinical studies should compare both the catabolic and anabolic effects of these agents on bone.
Insights
Bisphosphonates are standard for treating multiple myeloma bone disease, with zoledronic acid showing superiority despite side effects. Newer agents like denosumab and proteasome inhibitors offer promising therapeutic potential.
Area of Science:
- Oncology
- Bone Metabolism
- Pharmacology
Background:
- Multiple myeloma frequently causes bone disease, impacting patient quality of life and survival.
- Therapeutic advancements include immunomodulating agents, proteasome inhibitors, and receptor activator of nuclear factor κB ligand inhibitors.
Purpose of the Study:
- To review current and emerging treatments for multiple myeloma bone disease.
- To evaluate the efficacy and safety of various therapeutic agents.
Main Methods:
- Systematic literature review of in vitro, in vivo, and clinical evidence.
- Databases searched: MEDLINE, EMBASE, and Google Scholar (1950-2014).
Main Results:
- Bisphosphonates (clodronate, pamidronate, zoledronic acid) are effective in preventing skeletal-related events.
- Zoledronic acid demonstrates superior efficacy and potential survival benefits.
- Denosumab shows comparable results to zoledronic acid, with ongoing evaluation.
- Proteasome inhibitors are under investigation for their bone-protective effects.
Conclusions:
- Bisphosphonates remain the primary treatment for myeloma bone disease.
- Zoledronic acid is the preferred bisphosphonate, but requires side effect monitoring.
- Denosumab is a viable alternative, though further evidence is needed.
- Emerging therapies, including proteasome inhibitors, hold significant promise for managing myeloma-induced bone complications.
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