Zoledronic acid , also known as zoledronate , is a drug used to treat a number of bone diseases. These include osteoporosis, high blood calcium from cancer, bone damage from cancer, and Paget's bone disease. This is given by injection into a blood vessel.
Common side effects include fever, joint pain, high blood pressure, diarrhea, and fatigue. Serious side effects may include kidney problems, low blood calcium, and jaw osteonecrosis. Use during pregnancy can cause harm to the baby. This is in the drug bisphosphonate family. It works by blocking the activity of osteoclast cells and thereby reducing bone damage.
Zoledronic acid was approved for medical use in the United States in 2001. This is a List of Essential Medicines of the World Health Organization, the most effective and safe medicines needed in the health system. The cost of wholesale in developing countries is between 5.73 USD and 26.80 USD per bottle. In the UK, by 2015, the dose of NHS costs about 220 pounds.
Video Zoledronic acid
Medical use
Cancer bone complications
Zoledronic acid is used to prevent skeletal fractures in patients with cancers such as multiple myeloma and prostate cancer, as well as to treat osteoporosis. It can also be used to treat malignant hypercalcaemia and may help to treat pain from bone metastasis.
It can be given at home rather than in the hospital. Such use has demonstrated the safety and quality of life benefits in people with breast cancer and bone metastases.
Osteoporosis
Zoledronic acid may be given as a 5 mg infusion once a year for the treatment of osteoporosis in postmenopausal men and women at an increased risk of fracture.
In 2007, the US Food and Drug Administration (FDA) also approved for the treatment of postmenopausal osteoporosis.
Paget's disease
A single dose of 5 mg of zoledronic acid is used for the treatment of Paget's disease.
Maps Zoledronic acid
Contraindications
- Poor kidney function (eg CrCl & lt; 30 mL/min)
- Hypocalcemia
- Pregnancy
- Paralysis
Side effects
Side effects can include fatigue, anemia, muscle pain, fever, and/or swelling in the legs or feet. Common flu-like symptoms occur after the first infusion, though not the next infusion, and is suspected to occur due to its potential to activate humans ?? T cells (T gamma/delta cells).
Kidney
There is a risk of severe kidney disorders. Appropriate hydration is important before administration, such as adequate intake of calcium and vitamin D prior to Aclasta therapy in patients with pre-existing hypocalcemia, and for ten days after Aclasta in patients with Paget's bone disease. Monitoring for other mineral metabolism disorders and avoiding invasive dental procedures for those who develop jaw osteonecrosis is recommended.
Zoledronate is quickly processed through the kidneys; consequently administration is not recommended for patients with impaired renal function or kidney disease. Several cases of acute renal failure requiring dialysis or having fatal results after the use of Reclast have been reported to the US Food and Drug Administration (FDA). This assessment was confirmed by the European Medicines Agency (EMA), the Committee for Drugs for Human Use Products (CHMP) established a new contraindication for treatment on December 15, 2011, which included hypocalcemia and severe renal impairment with creatinine clearance of less than 35 ml/min
Bone
A rare complication recently observed in cancer patients treated with bisphosphonates is osteonecrosis of the jaw. This is especially evident in patients with multiple myeloma treated with zoledronate who have performed tooth extraction.
Atypical fracture: After approving the drug on July 8, 2009, the European Medicines Agency conducted a class review of all bisphosphonates, including Zoledronate, after several cases of atypical fracture were reported. In 2008, the EMA Pharmacovigilance Working Party (PhVWP) noted that alendronic acid was associated with an increased risk of atypical femur fractures that developed with low or absent trauma. In April 2010, PhVWP noted that further data from both published literature and post-marketing reports are now available which show that atypical femoral stress fractures may be a class effect. The European Medicines Agency then reviews all case reports of stress fractures in patients treated with bisphosphonates, relevant data from published literature, and data provided by companies marketing bisphosphonates. The Agency recommends that physicians prescribing bisphosphonate drugs should be aware that atypical fractures may be rare in the femur, especially after prolonged use, and that doctors prescribing these drugs for prevention or treatment of osteoporosis should regularly review the need for care continued, especially after five or more years of use.
Action mechanism
Zoledronic acid slows bone resorption, allowing bone-forming cells to rebuild normal bone and allow bone remodeling.
Research
Zoledronic acid has been found to have a direct antitumor effect and synergistically adds to the effects of other antitumor agents in osteosarcoma cells.
Zoledronate has shown significant benefits compared with placebo for three years, with reduced number of vertebral fractures and increased bone density. The annual dose of zoledronic acid may also prevent recurrent fractures in patients with previous hip fractures.
Zoledronate also weakens the accumulation of DNA damage in mesenchymal stem cells and protects its function. Given these characteristics, its potential to affect conditions arising from stem cell dysfunction makes it a promising remedy for many age-related diseases.
With hormone therapy for breast cancer
Increased disease-free survival (DFS) is found in ABCSG-12 trials, in which 1,803 premenopausal women with endocrine-responsive early breast cancer receive anastrozole with zoledronic acid. A retrospective analysis of AZURE trial data revealed the survival advantages of DFS, especially where estrogen has diminished.
In a trial meta-analysis where upstream zoledronic acid is administered to prevent bone loss associated with aromatase inhibitors, the recurrence of active cancer appears to be reduced.
In 2010 "The results of a clinical study of adjuvant treatment in the early stages of hormone-receptor-positive breast cancer patients under hormonal treatment - especially with zoledonic bisphosphonate acid - caused excitement as they showed an additive effect on decreasing the relapse of bone disease or a number of other sites A number of clinical studies and in vitro and in vivo , are ongoing or just over, are investigating the mechanisms of action and antitumoral activity of bisphosphonates. "
A 2010 review concluded that "adding 4 mg intravenous zoledronic acid every 6 months for endocrine therapy in premenopausal women with hormone-positive receptors of early breast cancer... is cost-effective from the perspective of the US health care system."
References
External links
Source of the article : Wikipedia
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