Multiple Myeloma Coverage from Every Angle

Bone-Directed Therapy in Myeloma: How Often Should Bisphosphonates Be Given?

By: Vanessa A. Carter, BS
Posted: Friday, September 3, 2021

According to Gregory S. Calip, PharmD, MPH, PhD, of the University of Illinois at Chicago, and colleagues, the risk of recurrent skeletal-related events seemed to be reduced no matter how often intravenous bisphosphonates were administered to patients with multiple myeloma. Published in JAMA Network Open, these results also appear to support relative safety, regarding skeletal-related event risk, when the frequency of bisphosphonate therapy is decreased.

“In clinical practice, there are many reasons why oncologists administer intravenous bisphosphonates at longer dosing intervals, and additional attention should consider the potential benefits and risks of more or less frequent bone-directed therapy,” the study authors noted.

The data of 4,281 eligible patients with multiple myeloma who initiated intravenous bisphosphonate therapy were retrospectively reviewed for this study. The frequency of administration of bisphosphonates was defined as intervals of every 4 weeks or delayed intervals of 5 to 8 weeks, 9 to 12 weeks, or longer than 12 weeks.

The mean patient age at diagnosis was 64.8 years, and 57.3% of patients were men. The median follow-up was 13.3 months since a diagnosis of multiple myeloma. At least one skeletal-related event was observed in 60% of patients, and at follow-up, 3,345 skeletal-related events were recorded. Of note, the overall rate for these events after 180 days was 96.2 events per 100-person years.

Adjusted Andersen-Gill risk estimates of the dosing intervals of longer than 12 weeks (hazard ratio [HR] = 0.90), 5 to 8 weeks (HR = 1.00), and 9 to 12 weeks (HR = 0.95) were not statistically significant when compared with the dosing schedule of every 4 weeks. Additionally, there were no observed clinically meaningful or significant differences observed regarding first and subsequent risks of skeletal-related events, according to Prentice-Williams-Peterson models.

Disclosure: For full disclosures of the study authors, visit

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