Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study

<h3>Objective</h3><p dir="ltr">To identify the incidence of hypercalcemia and hypocalcemia in zoledronic acid and denosumab groups. Secondary objective was to determine the correlation between calcium supplement and calcium level control.</p><h3>Methods</h3...

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Main Author: Sahar M Nasser (18090838) (author)
Other Authors: Arwa Sahal (18061027) (author), Anas Hamad (9545771) (author), Shereen Elazzazy (9545774) (author)
Published: 2019
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author Sahar M Nasser (18090838)
author2 Arwa Sahal (18061027)
Anas Hamad (9545771)
Shereen Elazzazy (9545774)
author2_role author
author
author
author_facet Sahar M Nasser (18090838)
Arwa Sahal (18061027)
Anas Hamad (9545771)
Shereen Elazzazy (9545774)
author_role author
dc.creator.none.fl_str_mv Sahar M Nasser (18090838)
Arwa Sahal (18061027)
Anas Hamad (9545771)
Shereen Elazzazy (9545774)
dc.date.none.fl_str_mv 2019-01-07T03:00:00Z
dc.identifier.none.fl_str_mv 10.1177/1078155218820927
dc.relation.none.fl_str_mv https://figshare.com/articles/journal_contribution/Effect_of_denosumab_versus_zoledronic_acid_on_calcium_levels_in_cancer_patients_with_bone_metastasis_A_retrospective_cohort_study/25331212
dc.rights.none.fl_str_mv CC BY 4.0
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv Biomedical and clinical sciences
Oncology and carcinogenesis
Pharmacology and pharmaceutical sciences
Denosumab
zoledronic acid
bone metastasis
cancer
hypocalcemia
dc.title.none.fl_str_mv Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
dc.type.none.fl_str_mv Text
Journal contribution
info:eu-repo/semantics/publishedVersion
text
contribution to journal
description <h3>Objective</h3><p dir="ltr">To identify the incidence of hypercalcemia and hypocalcemia in zoledronic acid and denosumab groups. Secondary objective was to determine the correlation between calcium supplement and calcium level control.</p><h3>Methods</h3><p dir="ltr">An observational retrospective cohort study was conducted by reviewing patient electronic records, laboratory results, and medication charts from 1 August 2015 to 31 July 2016. Adult cancer patients who were diagnosed with bone metastasis secondary to a solid tumor or multiple myeloma and who received either zoledronic acid or denosumab were included. Other indications for bone targeting agents were excluded. Data of bone targeting agents administration encounters were collected, evaluated, and analyzed.</p><h3>Results</h3><p dir="ltr">A total of 1141 encounters (for 271 patients) were included. The incidence of hypocalcemia was higher in denosumab compared to zoledronic acid group (5.5% vs. 3.1%, OR = 0.55, 95% CI [0.3–1.0]; P = 0.05). Hypercalcemia incidence was also higher in denosumab group (8.5% vs. 3.1%, OR = 2.9, 95% CI [1.68–5.03]; P < 0.0001). Breast cancer was the most common malignancy associated with hypocalcemia (27.3%) followed by ovarian cancer (25%) and multiple myeloma (22.7%). The risk of developing hypocalcemia was reduced by 16% in patients receiving calcium supplementation (RR = 0.84, 95% CI [0.55–1.20]; P = 0.39).</p><h3>Conclusion</h3><p dir="ltr">Denosumab use was associated with higher rates of both hypercalcemia and hypocalcemia compared to zoledronic acid. Adequate supplementation with calcium substantially reduced the risk of hypocalcemia. Our results highlight the importance of taking preventative measures upon bone targeting agents initiation and during treatment including regular monitoring of calcium levels and providing supplements accordingly.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Oncology Pharmacy Practice<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" target="_blank">https://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1177/1078155218820927" target="_blank">https://dx.doi.org/10.1177/1078155218820927</a></p>
eu_rights_str_mv openAccess
id Manara2_96ff461e1d4bba68dc510835ebe2c9e0
identifier_str_mv 10.1177/1078155218820927
network_acronym_str Manara2
network_name_str Manara2
oai_identifier_str oai:figshare.com:article/25331212
publishDate 2019
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rights_invalid_str_mv CC BY 4.0
spelling Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort studySahar M Nasser (18090838)Arwa Sahal (18061027)Anas Hamad (9545771)Shereen Elazzazy (9545774)Biomedical and clinical sciencesOncology and carcinogenesisPharmacology and pharmaceutical sciencesDenosumabzoledronic acidbone metastasiscancerhypocalcemia<h3>Objective</h3><p dir="ltr">To identify the incidence of hypercalcemia and hypocalcemia in zoledronic acid and denosumab groups. Secondary objective was to determine the correlation between calcium supplement and calcium level control.</p><h3>Methods</h3><p dir="ltr">An observational retrospective cohort study was conducted by reviewing patient electronic records, laboratory results, and medication charts from 1 August 2015 to 31 July 2016. Adult cancer patients who were diagnosed with bone metastasis secondary to a solid tumor or multiple myeloma and who received either zoledronic acid or denosumab were included. Other indications for bone targeting agents were excluded. Data of bone targeting agents administration encounters were collected, evaluated, and analyzed.</p><h3>Results</h3><p dir="ltr">A total of 1141 encounters (for 271 patients) were included. The incidence of hypocalcemia was higher in denosumab compared to zoledronic acid group (5.5% vs. 3.1%, OR = 0.55, 95% CI [0.3–1.0]; P = 0.05). Hypercalcemia incidence was also higher in denosumab group (8.5% vs. 3.1%, OR = 2.9, 95% CI [1.68–5.03]; P < 0.0001). Breast cancer was the most common malignancy associated with hypocalcemia (27.3%) followed by ovarian cancer (25%) and multiple myeloma (22.7%). The risk of developing hypocalcemia was reduced by 16% in patients receiving calcium supplementation (RR = 0.84, 95% CI [0.55–1.20]; P = 0.39).</p><h3>Conclusion</h3><p dir="ltr">Denosumab use was associated with higher rates of both hypercalcemia and hypocalcemia compared to zoledronic acid. Adequate supplementation with calcium substantially reduced the risk of hypocalcemia. Our results highlight the importance of taking preventative measures upon bone targeting agents initiation and during treatment including regular monitoring of calcium levels and providing supplements accordingly.</p><h2>Other Information</h2><p dir="ltr">Published in: Journal of Oncology Pharmacy Practice<br>License: <a href="https://creativecommons.org/licenses/by/4.0/" target="_blank">https://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1177/1078155218820927" target="_blank">https://dx.doi.org/10.1177/1078155218820927</a></p>2019-01-07T03:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1177/1078155218820927https://figshare.com/articles/journal_contribution/Effect_of_denosumab_versus_zoledronic_acid_on_calcium_levels_in_cancer_patients_with_bone_metastasis_A_retrospective_cohort_study/25331212CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/253312122019-01-07T03:00:00Z
spellingShingle Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
Sahar M Nasser (18090838)
Biomedical and clinical sciences
Oncology and carcinogenesis
Pharmacology and pharmaceutical sciences
Denosumab
zoledronic acid
bone metastasis
cancer
hypocalcemia
status_str publishedVersion
title Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
title_full Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
title_fullStr Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
title_full_unstemmed Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
title_short Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
title_sort Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study
topic Biomedical and clinical sciences
Oncology and carcinogenesis
Pharmacology and pharmaceutical sciences
Denosumab
zoledronic acid
bone metastasis
cancer
hypocalcemia