Hypercalcaemia: Pamidronate achieved normocalcaemia better than mithramycin.

Clinical bottom line (level 1b)

Patients with tumour-associated hypercalcaemia who were given pamidronate were more likely to achieve normoglycaemia, than those given mithramycin (NNT = 1 at 6 days) .

Ostenstad and Andersen: Acta Oncologica 1992; 31 (8): 861-864

Expires January 2001

The study

Double-blinded ?concealed randomised trial without intention-to-treat
Setting: oncology department, Norway

25 patients (aged ?, ?% male) symptomatic tumour-associated hypercalcaemia (albumin-corrected serum calcium >2.8 mmol/L) which failed to respond to 48h IV hydration and furosemide

Excluded if

severe primary renal or heart failure

normocalcaemia within 48 hours

rapid deterioration and death

Note:

28% had lung cancer

18% had breast cancer

Control Group: (n = 11, 11 analysed): mithramycin 1.25 mg in 500 ml saline infusion over 4 hours. A second optional dose was allowed within three days of inclusion.
Experimental Group: (n = 14, 14 analysed): pamidronate disodium 30-90 mg in 1000 ml saline over 12 hours. The dose was varied according to serum calcium level.
All patients were given saline infusion and furosemide in a standardised manner.
100% followed for 6 days
Outcome notes:

normocalcaemic : serum calcium 2.8 mmol/L or less

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
normocalcaemic	6 days	3 (27.3%)	14 (100%)	100% (?% to 100%)	72.66% (46.41% to 99.05%)	1 (1 to 2)

12 out of 14 patients (86%) in the pamidronate group were still normocalcaemic at 12 days.

Citation

Ostenstad B, and Andersen OK: Disodium pamidronate versus mithramycin in the management of tumour-associated hypercalcaemia. Acta Oncologica 1992; 31 (8): 861-864

Contributor: Clare Wotton and Musab Hayatli, January 2000
Reviewer: Chris Williams

_{Clinical Question.}

_Patient	_{tumour-associated hypercalcaemia}
_{Intervention or Exposure}	_pamidronate
_Comparison	_mithramycin
_Outcome	_{serum calcium}