Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative .
Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting .
Purpose To up date guideline recommendations on the role of bone-modifying agents in multiple myeloma .
Effects of induction and maintenance plus long-term bisphosphonates on bone disease in patients with multiple myeloma: the Medical Research Council Myeloma IX Trial.
The Medical Research Council Myeloma IX Trial ( IS RCT NG8454111 ) examined traditional and thalidomide-based induction and maintenance regimens and IV zoledronic acid ( ZOL ) and oral clodronate ( CLO ) in 1960 patients with newly diagnosed multiple myeloma .  Overall survival ( OS ) and skeletal-related event ( SRE ) data have been reported for the overall trial population . The present analysis investigated optimal therapy regimens for different patient population s in Myeloma IX . Patients were assigned to intensive or nonintensive treatment pathways and r and omized to induction cyclophosphamide , vincristine , doxorubicin , and dexamethasone ( CVAD ) versus cyclophosphamide , thalidomide , and dexamethasone ( CTD ; intensive ) or melphalan and prednisolone versus attenuated oral CTD ( CTDa ; nonintensive ) . Patients were also r and omized to ZOL or CLO . In the nonintensive pathway , CTDa produced better responses and lower SRE rates than melphalan and prednisolone . ZOL improved OS compared with CLO independently of sex , stage , or myeloma subtype , most profoundly in patients with baseline bone disease or other SREs . In patients treated for ≥ 2 years , ZOL improved OS compared with CLO from r and omization ( median not reached for either ; P = .02 ) and also from first on- study disease progression ( median , 34 months for ZOL vs 27 months for CLO ; P = .03 ) . Thalidomide-containing regimens had better efficacy than traditional regimens , and ZOL demonstrated greater benefits than CLO
Denosumab has shown to be noninferior to zoledronic acid for the prevention of skeletal-related events and provides an alternative .
Fewer adverse events related to renal toxicity have been noted with denosumab compared with zoledronic acid and may be preferred in this setting .
Purpose To up date guideline recommendations on the role of bone-modifying agents in multiple myeloma .