경구용 비스포스포네이트의 사전 투여는 졸레드로네이트의 급성이상반응을 줄일 수 있는가?
Could Prior Oral-bisphosphonate Administration Reduce the Acute Phase Reaction of Zoledronate?
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연구목적: 정주용 비스포스포네이트인 졸레드로네이트를 투여하기 전에 최소 2주 이상 경구용 비스포스포네이트를 사전투여하는 방법에서의 급성이상반응 (acute phase reaction, APR)의 발생율을 분석하고, 이를 기존 투여방법과 비교분석하였다. 연구방법: 경북대학교병원에서 2009년 7월부터 2010년 10월까지 골다공증으로 진단을 받은 환자 중 최소 2주 이상 최대52주 (평균 18.5주) 동안 경구용 비스포스포네이트를 사전 복용한 후 휴지기 없이 5 mg 졸레드로네이트를 정주 투여 받은 27명 (42~85세, 평균 70.8세)을 대상으로 APR 발생율을 조사하였다. APR에는 발열 (fever), 플루와 같은 증상 (무력감 포함), 두통, 관절통 (arthralia) 그리고 근육통 (myalgia)을 세부항목으로 정하였고, 추가적으로 시각적 통증척도 (visual analogue scale, VAS)를 통하여 통증의 정도를 포함한 설문조사를 하였다. 결 과: APR을 5그룹으로 세분하고 VAS scale까지 포함된 설문조사에서 27명의 환자 중 독감과 같은 증상과 근육통은 각각 14.8%와 7.4%이었으며, 발열, 관절통, 그리고 두통은 각각 3.7%이었다. VAS에서는 모든 반응은 경미한 단계이었다. 이는 기존에 보고된 졸레드로네이트의 APR 발생비율보다 통계학적으로 유의하게 감소된 결과이었다. 결 론: 골다공증을 치료하기 위하여 5 mg 졸레드로네이트를 정맥주사하기 전에 경구용 비스포스포네이트 제제를 2주이상 사전 투여한 후 졸레드로네이트를 정맥 투여하는 방법은 졸레드로네이트의 급성이상반응을 경감할 수 있는 좋은대안으로 판단된다.
Abstract
Objective: Bisphosphonates are the most commonly prescribed medications for the treatment of osteoporosis. This study was designed to analyze the rate of acute phase reaction (APR) following Zoledronate 5 mg administration in patients with osteoporosis who were treated with prior oral bisphosphonate for at least 2 weeks and to compare naïve IV 5 mg Zoledronate. Methods: Between July 2009 and October 2010, 27 patients with osteoporosis who were treated with prior oral bisphosphonate for at least 2 weeks, and maximum 52 weeks (average 18.5 weeks) and were between 42-and 85-year-old at the time of study participation. We prospectively evaluated APR, including fever, flu-like symptoms,headache, arthralgia, and myalgia, after 5 mg zoledronate by questionnaire. Additionally we assessed a visual analogue scale (VAS) by 4-point categorical scale. Results: In this study of 27 patients with osteoporosis, the frequency of APR, flu-like symptom and myalgia were 14.8% and 7.4% and fever, arthralgia, and headache were 3.7% respectively. In VAS, all reactions were mild. The rate of APR rate in this study was statistically decreased compared to previous reports with zoledronate 5 mg IV in bisphosphonate-naïve patients. Conclusion: Prior oral bisphosphonate administration for at least 2 weeks could significantly reduce the APR of IV zoledronate 5 mg. [Korean Journal of Bone Metabolism, 18(1): 49-54, 2011]
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