MANAGEMENT OF PAGET'S OISEASE OF BONE o Human Calcitonin is Safe and Highly Effective The use of human calcitonin in the treatment of Paget's disease has been stimulated by the ability of chemists to synthesise it in large quant ities and development of resistance to porcine and salmon calcitonin in some patients [1). A recent symposium at the eiba Foundation in London brought together much of the world 's experience with humar. calcitonin. Studies have shown pain to be markedly reduced in several groupsofpalienlS- 13 of 14 in one instance. 4 of 4 in another. Biochem ical indices have improved in most cases. Urinary excretion of hydroxyproline falls gradually - by 50 % in 89 patients (maximum 85 %). The degree of reduction did not seem to correlate closely with initial daily dose or mode of admini stration. The response to 1-2mg da ily was no greater than to O.25-0.5mg dail y; nor did there seem any difference between on ce or twice daily dosage. Alternate- day dosage increased hydrox yproline excretion in 3 of 5 patients given 0 .5mg daily for I year. Serum alkaline phosphatase fall s to a similar degree to urinary hydroxyprolin e. but the palle rn of s Uppression is di ffere nt. with a week's delay be fore a deC r ease occurs. Radio l ogic improvement in 28 patients over [0·40 months was dose-related. with patients on I mg daily improving or not worsening. while results were variable with O.5mg da il y. and there was no improvement wi th O.5mg given 3 times week ly . Facial nush was the most common side-e lTect. occu rring in 71 % of 33 patients given I mg 1M. and nausea the next most oommon . Symptoms ge n era ll y h ave respo n ded to dose reduction. o Mithramycin Has Dramatic Effects, but Should be Used with Care Mithramyc in in low chemotherapeutic doses was given to 2 patients with Paget's disease . with dramatic effect on serum alkaline phosphatase and urinary hydroxyproline 12L In I patient thi s was accompan i ed by symptomatic relief of bone pain and of congestive heart failure wh i ch had been intractable to other trea tments. Si n ce then. a funher 150 patients have bee n treated with genera ll y s im ilar results . Bone sca ns h ave returned to normal and there has bee n a progress ive remodelling of bone towards normal appearance. The prime limiting factor to date in USing enough of the dru g to completely control or eradicate the disease has been nephrotoxicit y encountered in about 5% ofpat ie nlS . Du ring therapy with mithramycin in dosages of 1 5-2Sp.g / kg / da y transiem enzyme increases. presumably due to liver toxi ci ty , have been seen . Thus the drug s hould be used with caution. [II Singer. F.R.: Oinical Orthopaedics a nd Related Research 127: 116 (Sep 1917) [21 Ryan. W.e .: Ibid 127: I06($ep 197 7) INPHARMA 14th January. 1978 p9

MANAGEMENT OF PAGET’S DISEASE OF BONE

Download PDF Report

Upload
nguyendung
View
217
Download
4

Embed Size (px)

Citation preview

Page 1: MANAGEMENT OF PAGET’S DISEASE OF BONE

MANAGEMENT OF PAGET'S OISEASE OF BONE

o Human Calcitonin is Safe and Highly Effective The use of human calcitonin in the treatment of Paget's disease has been stimulated by the ability of chemists to synthesise it in large quantities and development of resistance to porcine and salmon calcitonin in some patients [1). A recent symposium at the eiba Foundation in London brought together much of the world 's experience with humar. calcitonin. Studies have shown pain to

be markedly reduced in several groupsofpalienlS- 13 of 14 in one instance. 4 of 4 in another. Biochemical indices have improved in most cases. Urinary excretion of hydroxyproline falls gradually - by 50 % in 89 patients (maximum 85 %). The degree of reduction did not seem to correlate closely with initial daily dose or mode of administration. The response to 1-2mg daily was no greater than to O.25-0.5mg daily; nor did there seem any difference between once or twice daily dosage. Alternateday dosage increased hydrox yproline excretion in 3 of 5 patients given 0.5mg daily for I year. Serum alkaline phosphatase falls to a similar degree to urinary hydroxyproline. but the pallern of sUppression is differe nt. with a week's delay before a deCrease occurs. Radiologic improvement in 28 patients over [0·40 months was dose-related. with patients on I mg daily improving or not worsening. while results were variable with O.5mg daily. and there was no improvement with O.5mg given 3 times weekly. Facial nush was the most common side-elTect. occurring in 71 % of 33 patients given I mg 1M. and nausea the next most oommon. Symptoms generally have responded to dose reduction.

o Mithramycin Has Dramatic Effects, but Should be Used with Care Mithramycin in low chemotherapeutic doses was given to 2 patients with Paget's disease. with dramatic effect on serum alkaline phosphatase and urinary hydroxyproline 12L In I patient this was accompanied by symptomatic relief of bone pain and of congestive heart failure wh ich had been intractable to other treatments. Since then. a funher 150 patients have been treated with generally similar results. Bone scans have returned to normal and there has been a progressive remodelling of bone towards normal appearance. The prime limiting factor to date in USing enough of the drug to completely control or eradicate the disease has been nephrotoxicity encountered in about 5% ofpatienlS. During therapy with mithramycin in dosages of 15-2Sp.g/ kg/ day transiem enzyme increases. presumably due to liver toxicity, have been seen . Thus the drug should be used with caution.

[II Singer. F.R.: Oinical Orthopaedics and Related Research 127: 116 (Sep 1917) [21 Ryan. W.e.: Ibid 127: I06($ep 197 7)

INPHARMA 14th January. 1978 p9