19 Harley St, London, W1G 9QJ, UK

Bisphosphonates in a number of myeloma: an up to date community meta-analysis.

Related Articles

Bisphosphonates in a number of myeloma: an up to date community meta-analysis.

Cochrane Database Syst Rev. 2017 12 18;12:CD003188

Authors: Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B

BACKGROUND: Bisphosphonates are particular inhibitors of osteoclastic exercise and are used within the therapy of sufferers with a number of myeloma (MM). Whereas bisphosphonates are proven to be efficient in decreasing vertebral fractures and ache, their position in bettering general survival (OS) stays unclear. That is an replace of a Cochrane evaluate first revealed in 2002 and beforehand up to date in 2010 and 2012.
OBJECTIVES: To evaluate the proof associated to advantages and harms related to use of assorted kinds of bisphosphonates (aminobisphosphonates versus non-aminobisphosphonates) within the administration of sufferers with MM. Our major goal was to find out whether or not including bisphosphonates to straightforward remedy in MM improves OS and progression-free survival (PFS), and reduces skeletal-related morbidity. Our secondary targets have been to find out the consequences of bisphosphonates on ache, high quality of life, incidence of hypercalcemia, incidence of bisphosphonate-related gastrointestinal toxicities, osteonecrosis of jaw (ONJ) and hypocalcemia.
SEARCH METHODS: We searched MEDLINE, Embase (September 2011 to July 2017) and the CENTRAL (2017, Situation 7) to establish all randomized managed trial (RCT) in MM as much as July 2017 utilizing a mixture of textual content and MeSH phrases.
SELECTION CRITERIA: Any randomized managed trial (RCT) evaluating bisphosphonates versus placebo/no therapy/bisphosphonates and observational research or case reviews analyzing bisphosphonate-related ONJ in sufferers with MM have been eligible for inclusion.
DATA COLLECTION AND ANALYSIS: Two evaluate authors extracted the information. Information have been pooled and reported as hazard ratio (HR) or threat ratio (RR) utilizing a random-effects mannequin. We used meta-regression to discover statistical heterogeneity. Community meta-analysis utilizing Bayesian method was carried out.
MAIN RESULTS: On this replace, we included 4 new research (601 contributors), leading to a complete of 24 included research.Twenty RCTs in contrast bisphosphonates with both placebo or no therapy and 4 RCTs concerned one other bisphosphonate as a comparator. The 24 included RCTs enrolled 7293 contributors. Pooled outcomes confirmed that there was moderate-quality proof of a discount in mortality with on OS from 41% to 31%, however the confidence interval is in line with a bigger discount and small improve in mortality in contrast with placebo or no therapy (HR zero.90, 95% CI zero.76 to 1.07; 14 research; 2706 contributors). There was substantial heterogeneity among the many included RCTs (I2 = 65%) for OS. To clarify this heterogeneity we carried out a meta-regression assessing the connection between bisphosphonate efficiency and enchancment in OS, which discovered an OS profit with zoledronate however restricted proof of an impact on PFS. This offered an extra rationale for performing a community meta-analyses of the varied kinds of bisphosphonates that weren’t in contrast head-to-head in RCTs. Outcomes from community meta-analyses confirmed proof of a profit for OS with zoledronate in contrast with etidronate (HR zero.56, 95% CI zero.29 to zero.87) and placebo (HR zero.67, 95% CI zero.46 to zero.91). Nevertheless, there was no proof for a distinction between zoledronate and different bisphosphonates.The impact of bisphosphonates on illness development (PFS) is unsure. Based mostly on the HR of zero.75 (95% CI zero.57 to 1.00; seven research; 908 contributors), 47% contributors would expertise illness development with out therapy in contrast with between 30% and 47% with bisphosphonates (low-quality proof). There’s in all probability an identical threat of non-vertebral fractures between therapy teams (RR 1.03, 95% CI zero.68 to 1.56; six research; 1389 contributors; moderate-quality proof). Pooled evaluation demonstrated proof for a distinction favoring bisphosphonates in contrast with placebo or no therapy on prevention of pathological vertebral fractures (RR zero.74, 95% CI zero.62 to zero.89; seven research; 1116 contributors; moderate-quality proof) and skeletal-related occasions (SREs) (RR zero.74, 95% CI zero.63 to zero.88; 10 research; 2141 contributors; moderate-quality proof). The proof for much less ache with bisphosphonates was of very low high quality (RR zero.75, 95% CI zero.60 to zero.95; eight research; 1281 contributors).Bisphosphonates could improve ONJ in contrast with placebo however the confidence interval may be very huge (RR four.61, 95% CI zero.99 to 21.35; P = zero.05; six research; 1284 contributors; low-quality proof). The outcomes from the community meta-analysis didn’t present any proof for a distinction within the incidence of ONJ (eight RCTs, 3746 contributors) between bisphosphonates. Information from 9 observational research (1400 contributors) reported an incidence of 5% to 51% with mixture of pamidronate and zoledronate, three% to 11% with zoledronate alone, and zero% to 18% with pamidronate alone.The pooled outcomes confirmed no proof for a distinction in improve in frequency of gastrointestinal signs with using bisphosphonates in contrast with placebo or no therapy (RR 1.23, 95% CI zero.95 to 1.59; seven research; 1829 contributors; low-quality proof).The pooled outcomes confirmed no proof for a distinction in improve in frequency of hypocalcemia with using bisphosphonates in contrast with placebo or no therapy (RR 2.19, 95% CI zero.49 to 9.74; three research; 1090 contributors; low-quality proof). The outcomes from community meta-analysis didn’t present any proof for variations within the incidence of hypocalcemia, renal dysfunction and gastrointestinal toxicity between the bisphosphonates used.
AUTHORS’ CONCLUSIONS: Use of bisphosphonates in contributors with MM reduces pathological vertebral fractures, SREs and ache. Bisphosphonates have been related to an elevated threat of growing ONJ. For each 1000 contributors handled with bisphosphonates, about one affected person will endure from the ONJ. We discovered no proof of superiority of any particular aminobisphosphonate (zoledronate, pamidronate or ibandronate) or non-aminobisphosphonate (etidronate or clodronate) for any end result. Nevertheless, zoledronate was discovered to be higher than placebo and first-generation bisposphonate (etidronate) in pooled direct and oblique analyses for bettering OS and different outcomes similar to vertebral fractures. Direct head-to-head trials of the second-generation bisphosphonates are wanted to settle the problem if zoledronate is actually essentially the most efficacious bisphosphonate presently utilized in follow.

PMID: 29253322 [PubMed – indexed for MEDLINE]

Truspilot Reviews

Fabulous service Fabulous service. Mr Akmal truly cares about his patients and how he can improve their quality of life. I would recommend him to anyone with any kind of spinal issue.
Honeywell Paul
Honeywell Paul
Truly excellent results! I was diagnosed with lumbar stenosis after experiencing increasing pain in both legs. An MRI and consultation carried out at short notice confirmed this. Mr Akmal recommended that a spacer should be inserted in my lower back to correct the problem and release the nerves from the narrowing caused by stenosis. The operation was conducted very professionally and without pain. After the first two weeks the pain started to subside as expected. After 4 weeks I was completely back to normal. The result is exceptionally good and I feel renewed, with no pain whatsoever and a regained posture, ready to resume a normal life. I cannot recommend The London Spine Unit highly enough. They are medical magicians!
c etri
c etri
Sciatica My mother was in absolute agony for more than 3 months due to sciatica. It just came out of nowhere and took her out of action. From working full time she went straight to being bed bound and unable to carry out simplest of actions.The pain was 9/10 and she was bed bound for those three months. Multiple trips to A&E and GP and they wouldn't class it as an emergency therefore they wouldn't do anything about it other than upgrading the painkillers which did next to nothing for my mother. I couldn't bear to watch my mother sleeping on A&E bench in pain for 7 hours, just to be told by doctors that she wouldn't be kept in. I remember her joining her hands and begging the doctors to stop the pain which broke my heart. I then started doing research on google and London spine unit came up with Dr Mo AKMAL's profile and review. First meeting with Dr AKMAL was via ZOOM as my mother was bed bound. Dr AKMAL spoke to me and my mom and told us that this is nothing to worry about and that the pain would be 100% gone.Dr AKMAL assured us to visit the hospital so he could physically inspect my mother and give us the best solution. One trip to the london spine unit and Dr AKMAL advised us that the best solution would be to carry out Minimally invasive disectomy. Dr AKMAL advised that due to my mother being bed bound for a while, steroid injection might not give the result that my mother wishes. Dr AKMAL was very confident and showed us some videos from other patients who had gone through the same ordeal. The biggest thing i noticed between before and after was the smile on the patients face. Dr AKMAL was constantly assuring my mother throughout the meeting that he would take care of her pain and gave her 100% confidence that the result would be delivered.He promised her that she would be walking pain free the same day after the operation. Before the operation Dr GURUNG was consulted multiple times and he also was very helpful. Right after the surgery, as Dr AKMAL promised, my mother was walking and the biggest thing was that the pain was gone. My mother had forgotten to smile for three months and there i saw her smiling again. Dr AKMAL and Dr GURUNG gave us brilliant aftercare and informed us that just give them a ring if there was any issue. Its been several weeks now and my mother is heading towards complete recovery without any issues. The pain is completely gone and anyone who is reading this going through the same horrible sciatica pain you must come and see Dr AKMAL. Thank you Dr AKMAL and your whole team for helping my mom achieve this pain free life.
Frank Otuo
Frank Otuo
Extraordinary Care My 81 year old mother who has retired in Ghana was suffering from severe lower back pain so a local surgeon put her through discectomy with hardware (spine screws). The procedure was essentially botched, with one screw breaching her spinal canal resulting in extreme pain; unable to walk, pins and needles and numbness in the left leg. The hardware subsequently had become infected and loosened as a result. Her life after this surgery was the worse she has ever experienced in all her life. She had no doubt that she was eventually to die from the infection and pain. Fortunately, through diligent search, we found Mr Akmal and his team at The UK Spine Centre. She had a zoom consultation and with a ready MRI and CT scan, Mr Akmal knew exactly how to have her back to fitness and a better quality of life. She travelled to England on 26 March 2022 and had the surgery on 11 April 2022. It was a day-case. It lasted no more than 1 hour 30 minutes. She was on my feet within 2 hours pain free - still pain free 5 weeks on! To her this is simply a miracle ! She is grateful to Jehovah God for Mr Akmal and his team - thoroughly professional bunch at the top of their game. No one deserves to suffer the pain she experienced for two years. She seriously recommends Mr Akmal and his team for anything SPINE!
Luke O'Brien
Luke O'Brien
Bilateral discectomy and dynamic stabilisation for complete foot drop From the first phone call, the team at London Spine have been amazing. I had severe symptoms following an L4/L5 disc injury from playing sports and had complete foot drop. Mr Akmal and his team treated the situation incredibly sensitively, as I had risk of permanent damage. The whole process was so quick, from initial consultation to operation was about 96 hours. On the day of the operation, the nurses couldn’t have been more helpful, attentive and calming. The surgery was flawless, with absolutely zero pain from the operation following. I am now 8 weeks from a bi-lateral discectomy and dynamic stabilisation procedure and have regained full use of my leg and toes, with a complete range of motion also. Mr Akmal’s aftercare has been first class, with regular calls from his team in the 2 weeks following the surgery, to the final consultation and discharge. Thanks so much for giving me my life back
Excellent treatment Mr Mo Akmal treated me very successfully for 2 torn discs in my back. I was in tremendous pain before I was referred to him. The treatment I received from him was excellent and he communicated with me very well throughout the whole process. I am eternally grateful to Mr Akmal for sorting out my back and would highly recommend him.
shahnaz Choudhury
shahnaz Choudhury
I had a massive bulging disk on my back… I had a massive bulging disk on my back compressing my nerve for three years. It caused me excruciating pain and almost left me disabled. I was on both crutches and completely homebound due to the severity of pain and mobility limitations. I had my lumber surgery two weeks ago and walked out of hospital within a few hours pain free on my right leg that was almost paralysing prior to surgery. The disk was shaved off releasing the nerve completely. Two days after surgery I had excruciating pain on my head that is unexplained as I had CT scan and MRI which were all fine. Dr Akmal has suggested it could be from the anaesthetic. I am extremely grateful to Dr Akmal and his very welcoming and cari g team. I would highly recommend his clinic as I have had excellent recovery.
Thank you Mr Aklam After having a poor and very slow experiance in glasgow . I contacted Mr mo Amlam . Who is a true gentleman, great listener and paitent . We transfered my scans and treatments from glasgow to harley street . Mr Aklams p.a arranged a quick zoom to start our contact .I then went down for a meeting and examination and what should have been a spec scan .only to be told of a UK shortage . So 4 weeks later the scan took place in wellington hospital . Before I traveled back to glasgow. 5 days later I got a call to book me in to 19 harley street for a l3 and l4 debridement and stabilisation. The opp took place on 24th March. 2hours I was out walking 4 hours later . My pain in back groin and foot was all gone .thanks to Mr aklam . Top of his craft but more importantly pouts his patients first .he really wants to help you get better. Thank you so much Mr Robert harvey
Ken Carswell
Ken Carswell
Amazing service and an amazing treatment! I can't thank Mr Akmal and team at the London Spine Unit enough for their help. I had a herniated disc in my back which was causing pain and restrictions. Compared to other offers of surgery (e.g. several nights in hospital), the day surgery and minimally invasive procedure were hugely appealing. I am now 3 weeks post surgery, have no pain and am recovering incredibly quickly if I compare myself to friends who have had a similar procedure. it was truly remarkable, straightforward and the team were kind, friendly and always helpful. very highly recommended!
Great service and painless procedure Great service and painless procedure. Definitely alleviated the pain

London Spine Unit Harley Street Hospital

A Focus on High Quality Specialised Care

We are a specialist Private Hospital based on Harley Street, London UK The Harley Street Hospital, Day Surgery Hospital

We provide exclusive health services for individuals seeking Advanced medical, non-surgical or minimally invasive treatments. We are covered by All Insurance Companies apart from AXA PPP

Our Medical Director and Lead Spinal Surgeon Mr Mo Akmal MD is a world renowned Spine Specialist Consultant with over 20 years of experience. He and his team have developed revolutionary techniques to perform all types of Spinal Surgery as a Day Case procedure without traditional General Anaesthetic.

We are constantly improving our techniques for treatment and improving facilities for our patients.

Book your Appointment Now 
Check out our Reviews 
Check out our Patient Videos 
Check our Mr Akmal’s Profile


What our patients say ...

Bisphosphonates in a number of myeloma an up to date community meta-analysis | Posture corrector youtube

Revolutionary Keyhole surgical technique to vaporise bulging discs

Dr Mo Akmal Medical Director
Dr Mo Akmal MD - Lead Spinal Surgeon

Laser Disc Surgery can be performed under local anaesthetic at The Harley Street Hospital.

Initial Consultation

with Consultant Spine Surgeon
£ 250
  • No Waiting Times
  • Top NHS affiliated Consultant
  • Includes Clinical Review and Report
  • Multidisciplinary discussion
  • Review of Previous Scans and Reports

Follow up Consultation

any appointment after initial consultation
£ 180
  • Top NHS affiliated Consultant
  • Includes Clinical Review and Report
  • Multidisciplinary discussion

High Resolution MRI Scan

any Single Region (3.0 Tesla)
£ 600
  • No waiting times
  • Includes Full Radiologist Report
  • Open or Closed MRI scan types
  • Copy of Scan on CD

Website Offer

Pre-Booked Online
£ 800
  • Initial Consultation
  • MRI Scan (Single Region)
  • Follow Up consultation
  • Same Day One Stop Visit
  • Full Medical and MRI scan Report
  • Copy of scan on CD

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810