Multiple Myeloma-Associated Pain, Bone Fractures Managed With Type of Inhibitor


Adding a specific class of inhibitors to multiple myeloma treatment may not improve survival outcomes, but it does reduce overall pain and vertebral fractures, according to a new update published in the Cochrane Database of Systematic Reviews (doi: 10.1002/14651858.CD003188.pub4).

The updated network meta-analysis investigating the effects of bisphosphonate in multiple myeloma treatment included 24 trials spanning a total 7293 participants. Four of the randomized controlled trials compared a bisphosphonate with another bisphosphonate, while the remaining 20 compared bisphosphonates with placebo or no treatment.

“Bisphosphonates also alleviate pain without many side effects except a significant increase in reduced blood flow to bones of the jaw, resulting in decay of the bone also called osteonecrosis,” researchers reported. “Overall, for every 1000 participants treated with bisphosphonates, about one patient will suffer from the osteonecrosis of the jaw.”

Bisphosphonates did not reduce nonvertebral factures in patients, the review found.

The meta-analysis produced no evidence of superiority for any specific aminobisphosphonate (zoledronate, pamidronate, or ibandronate) or non-aminobisphosphonate (etidronate or clodronate) for any survival outcome.


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Researchers gauged the overall quality of evidence in the review as moderate to very low. They emphasized “the need for more research on this issue and specifically randomized controlled trials comparing different bisphosphonates directly instead of no treatment or placebo.”—Jolynn Tumolo