title: Renal toxicity in patients with multiple myeloma receiving zoledronic acid vs. ibandronate: a retrospective medical records review.
abstract: OBJECTIVE
  This retrospective study investigated the rates of renal impairment in patients with multiple myeloma treated with zoledronic acid and ibandronate.
  
  
  METHODS
  We retrospectively reviewed medical records in a German oncology clinic, from May 2001 to December 2005. Creatinine measurements were analyzed from baseline (before zoledronic acid or ibandronate treatment) to last evaluation for each patient. A total of 84 patients were included.
  
  
  RESULTS
  Zoledronic acid increased the risk of renal impairment by approximately 3-fold compared with ibandronate (renal impairment rates: zoledronic acid 37.7% vs. ibandronate 10.5%, relative risk [RR]=3.6, P=0.0029 serum creatinine [SCr]; 62.3% vs. 23.7%, RR=2.6, P=0.0001 glomerular filtration rate [GFR]). Ibandronate-treated patients switched from zoledronic acid had a significantly higher risk of renal impairment than patients receiving ibandronate monotherapy (zoledronic acid over ibandronate 39.1% vs. ibandronate monotherapy 6.7%, RR= 5.9, P=0.028 [SCr]; 65.2% vs 26.7%, RR=2.4, P=0.022 [GFR]). Multivariate analysis found significantly higher hazard ratios for zoledronic acid over ibandronate (SCr: Cox = 4.38, P=0.01; Andersen-Gill=8.22, P < 0.01; GFR: Cox = 4.31, P < 0.01; Andersen-Gill = 3.71, P < 0.01).
  
  
  CONCLUSIONS
  Overall, this retrospective study suggests that multiple myeloma patients are more likely to experience renal impairment with zoledronic acid than with ibandronate. The risk of renal impairment increased if patients had received prior therapy with zoledronic acid.
authors.affiliation: Praxisklinik für Hämatologie und Onkologie Koblenz, Koblenz, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Weide
authors.forename: Hubert
authors.initials: H
authors.lastname: Koppler
authors.forename: Lucia
authors.initials: L
authors.lastname: Antras
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.forename: M P H Eva
authors.initials: MP
authors.lastname: Chang
authors.forename: Jesse
authors.initials: J
authors.lastname: Green
authors.forename: Neil
authors.initials: N
authors.lastname: Wintfeld
authors.forename: Maureen P
authors.initials: MP
authors.lastname: Neary
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001847:Bone Diseases / Q000188:drug therapy* / Q000209:etiology; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D000077557:Ibandronic Acid; D007093:Imidazoles / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077557:Ibandronic Acid