What bisphosphonates should myeloma patients consider? There are several types of bisphosphonates. We have oral bisphosphonates and IV bisphosphonates. The IV bisphosphonates are iridia, enzomeda. Usually in multiple myeloma, we only give IV bisphosphonates. Why is this? We know that when you take oral bisphosphonates, that means a pill, the resorption is very low. And I think for our patients, it's really important that we guarantee that you have a sufficient drug level in your blood in order to inhibit the osteoclast. So that's why for the treatment of patients with multiple myeloma, you could receive isozomeda or iridia. What is better? Both are very active. The only difference is that zomeda is given within 15 minutes and iridia takes two hours, sometimes even longer. So the zomeda is more convenient for our patients, but in terms of efficacy, both drugs are equivalent. Who should be prescribed bisphosphonate therapy? Everybody who has active multiple myeloma and starts treatment for multiple myeloma should also start bisphosphonate therapy. In case you need treatment again for a relapsed multiple myeloma, in this case, I restart to give bisphosphonates. In our clinical practice, we try to treat the majority of patients with a bisphosphonate, such as iridia or zomeda. And the reason is because even if these medications are discontinued, they still last in the skeleton for a while and continue to be effective. We typically reserve the dinosumab or xg for patients who have active bone disease, but also have a significant decline in kidney function so that in those patients, we're not sure that the bisphosphonates like iridia or zomeda are safe. And so in those patients, typically xgeva might be a better choice. But in our clinical practice, unless you have renal dysfunction or there's some other reason, like an allergic reaction or something to the bisphosphonate, we typically like to use the bisphosphonate first, unless it can't be given for one of those reasons like kidney function.
HealthTree • April 30, 2020