A systematic review of the role of bisphosphonates in metastatic disease.

摘要: Objectives: To identify evidence for the role of bisphosphonates in malignancy treatment hypercalcaemia, prevention skeletal morbidity and use adjuvant setting. perform an economic review current literature model cost effectiveness hypercalcaemia Data sources: Electronic databases (1966-June 2001). Cochrane register. Pharmaceutical companies. Experts field. Handsearching abstracts leading oncology journals (1999-2001). Review methods: Two independent reviewers assessed studies inclusion, according to predetermined criteria, extracted relevant data. Overall event rates were pooled a meta-analysis, odds ratios ( OR) given with 95% confidence intervals (CI). Where data could not be combined, reported individually proportions compared using chi- squared analysis. Cost cost-effectiveness by decision analytic comparing different bisphosphonate regimens hypercalcaemia; Markov models employed evaluate prevent skeletal-related events (SRE) patients breast cancer multiple myeloma. Results: For acute malignancy, normalised serum calcium >70% within 2-6 days. Pamidronate was more effective than control, etidronate, mithramycin low-dose clodronate, but equal high dose achieving normocalcaemia. prolongs doubles) median time relapse clodronate or etidronate. morbidity, placebo, significantly reduced OR fractures (OR [95% CI], vertebral, 0.69 [0.57-0.84], non-vertebral, 0.65 [0.54-0.79], [0.55-0.78]) radiotherapy 0.67 [0.57-0.79] 0.54 [0.36-0.81] orthopaedic surgery 0.70 [0.46-1.05] spinal cord compression 0.71 [0.47-1.08]. However, reduction significant that lasted over year 0.59 [0.39-0.88]. Bisphosphonates increased first SRE did affect survival. Subanalyses performed disease groups, drugs route administration. Most supports intravenous aminobisphosphonates. bisphosphonates, Clodronate, primary operable no metastatic disease, number developing bone metastases. This benefit maintained once regular administration had been discontinued. trials survival advantages treated groups. reduce metastases both early advanced cancer. are well tolerated low incidence side-effects. Economic modelling showed longest cumulative duration normocalcaemia most cost-effective. Zoledronate 4 mg costly, cost-effective treatment. estimated overall therapy pound250 pound1500 per myeloma, respectively. Bisphosphonate is sometimes cost-saving where prevented. Conclusions: High aminobisphosphonates delay relapse. SREs bony do Benefit demonstrated after at least 6-12 months. The greatest body Further required support