Assessing Clinician Prescribing Practices for Prophylaxis and Treatment of Acute Phase Responses Following IV...

There appear to be no definitive guidelines on optimal prevention and management of acute phase responses (APRs) following intravenous bisphosphonates (IVBP) for osteoporosis. Our objective was to identify physician prescribing practices for supplementary therapy aimed at managing APRs and whether these were thought beneficial.

An online survey was distributed to members of key Australian societies for geriatrics, rheumatology and endocrinology (membership n ≈ 2900) with questions assessing if respondents prescribed IVBP, their experience managing APRs including medications used and whether these were beneficial.

Seventy-five responses were collected from geriatricians, endocrinologists and rheumatologists, with 68 respondents prescribing IVBP for osteoporosis. Overall, 84% (57/68) of those using IVBP previously managed a post-IVBP APR and 24% (16) reported risk of APR could influence their prescribing. Eighty-eight percent (60) of those using IVBP reported using paracetamol for APR management, whereas 41% (28) used NSAIDs and 53% (36) used corticosteroids. There was considerable variability in reported prescribing plans. Only 50% (30) of clinicians using paracetamol and 42% (11) of those using NSAIDs reported finding these beneficial for APR management, whereas 92% (33) of those using corticosteroids reported observing benefit. Ninety-four per cent (34) of clinicians prescribing corticosteroids did so on a case-by-case basis.

Despite limited numbers, the results of this pilot work indicated clinicians used various medications to offset post-IVBP APRs and some reported that they had observed benefit in terms of APR prevention or treatment, supporting the need for further clinical trials to establish which, if any, are associated with improved clinical outcomes.