Although bisphosphonate drugs can reduce pain and bone fractures in individuals with multiple myeloma, no one drug is superior, according to a systematic review of the current evidence of these drugs. The review is published in The Cochrane Library.

Multiple myeloma is a type of cancer that grows in and on bones. The disease can cause fractures in the spine and long bones. Bisphosphonate drugs are used to prevent or reduce the occurrence of bone fractures and pain in these patients and work by inhibiting the activities of osteoclasts (bone cells).

The team examined data on 6,692 myeloma patients from 20 trials who took bisphosphonate drugs in addition to their myeloma treatments. The bisphosphonate drugs included:

  • clodronate
  • etidronate
  • zoledronate
  • ibandronate
  • pamidronate

The researchers found that patients who took bisphosphnoates had reduced occurrence of pain and fractures. For all types of fractures, between 6 and 15 patients would require treatment in order to prevent fractures in 1 patient, according to their estimates, while 5 to 13 patients would need to be treated to reduce pain in 1.

4 of the 20 trials suggested that zoledronate was more effective than etidronate at reducing fractures. However, when the team made indirect comparisons by interrogating the data from the 20 trials (direct comparisons between different drugs; drug vs. placebo; and drug vs. no treatment), they found no drug to be superior.

Lead researcher of the study, Ambuj Kumar of the Center for Evidence Based Medicine and Health Outcomes Research at the University of South Florida, Tampa, Florida, explained:

“Whether zoledronate is superior to any other bisphosphonate drug remains an open question. In light of the inconsistencies we see in the data, it is difficult to recommend any drug as a preferential treatment for clinical practice.”

Although side effects of these drugs seem to be rare, one potential complication is osteonecrosis of the jaw. However, the researchers found that it is not more prevalent in patients taking bisphosphonate drugs than patients receiving placebo or no treatment.

Kumar concluded:

“We didn’t identify any significant adverse effects, but this work does highlight the need for larger head-to-head trials, which are needed to better compare the safety and effectiveness of the different drugs available.”

Written By Grace Rattue