Geng, C.J., Liang, Q., Zhong, J.H., Zhu, M., Meng, F.Y., Wu, N., . . . Yuan, B.Y. (2015). Ibandronate to treat skeletal-related events and bone pain in metastatic bone disease or multiple myeloma: A meta-analysis of randomised clinical trials. BMJ Open, 5(6), e007258-2014-007258. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effects of ibandronate relative to placebo or zolendronate for treatment of skeletal-related events and bone pain in patients with cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, Cochrane Collaboration
 
INCLUSION CRITERIA: Randomized, controlled trials comparing ibandronate to placebo or zoledronate; adult patients
 
EXCLUSION CRITERIA: Not specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 419
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Jadad scale was used to assess study quality. Average study quality was good. Studies with lower scores were open-label drug comparisons.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 8; 4 comparing ibandronate to placebo and 4 comparing to zolendronate
  • TOTAL PATIENTS INCLUDED IN REVIEW: 3,316
  • SAMPLE RANGE ACROSS STUDIES: 44–1,400 patients
  • KEY SAMPLE CHARACTERISTICS: Various tumor types; medications were given IV in some trials and orally in some trials

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship
 
APPLICATIONS: Palliative care

Results

IV or oral ibandronate was significantly better than placebo for pain reduction (WMD = -0.41, p < 0.00001). No significant differences in pain outcomes were seen between ibandronate and zoledronate. Incidence of renal toxicity was lower with ibandronate compared to zoledronate (RR = 0.71, p = 0.006). Incidence of skeletal-related events was lower with ibandronate compared to placebo (p = 0.002). There was no significant difference in skeletal-related events between ibandronate and zolendronate and no difference in other adverse events.

Conclusions

IV ibandronate every three to four weeks or daily oral medication was effective in reducing skeletal events and pain in patients with bone metastases, and was associated with lower incidence of renal toxicity than zoledronate.

Limitations

  • Almost all patients were Caucasian.
  • No subgroup analysis between IV and oral ibandronate administration

Nursing Implications

Ibandronate is effective in reducing pain from bone metastases and multiple myeloma, and in preventing skeletal events in these patients, with efficacy similar to that of zoledronate. This analysis also showed that ibandronate was associated with lower prevalence of renal toxicity compared to zoledronate, so it may be a preferred choice for some patients with relevant comorbid conditions. Further research is needed to fully compare efficacy of oral versus IV administration.

Legacy ID

5844