Hypercalcaemia: pamidronate decreased serum calcium in a dose response manner.

Clinical bottom line (level 1b)

  1. In patients with hypercalcaemia of malignancy, pamidronate decreased corrected serum calcium.
  2. The decrease in serum calcium with pamidronate had a dose response relationship, with 90 mg being better than both 30mg and 60 mg.
Nussbaum et al: American Journal of Medicine 1993; 95: 297-304
Expires June 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: four centre, USA

50 patients (aged mean 59 years, 64% male) hypercalcaemia (corrected serum calcium concentration of >12 mg/dl after hydration for 48 hours) of malignancy

Excluded if
  • aged <18 or >80 years old
  • skin malignancy
  • received any other hypocalcaemic therapy for at least one week prior to pamidronate infusion
  • received newly initiated chemotherapy or glucocorticoid therapy within one week of pamidronate
  • serum creatinine concentration >2.5 mg/dl after hydration


    • Control Group: (n = 15, 15 analysed): pamidronate 30 mg over 24 hours
    Experimental Group: (n = 18, 18 analysed): pamidronate 60 mg over 24 hours
    Experimental Group: (n = 17, 17 analysed): pamidronate 90 mg over 24 hours

    100% followed for 7 days

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    corrected serum calcium (mg/dl) after treatment- 30 mg vs 60 mg 11.6
    (2.50)     		10.5
    (1.50)     		1.10
    (-0.34 to 2.54)
    corrected serum calcium after treatment- 60 mg vs 90 mg 10.5
    (1.50)     		9.40
    (0.60)     		1.10
    (0.31 to 1.90)
    corrected serum calcium after treatment- 30 mg vs 90 mg 11.6
    (2.50)     		9.40
    (0.60)     		2.20
    (0.92 to 3.48)

  • Corrected serum calcium at baseline was similar in all three groups (approximately 13 mg).

    • Comments

    1. Exclusion of patients who received chemotherapy &/or steroid after commencing pamidronate may improve the apparent efficacy of the drug (as may have been introduced as rescue therapy)

    Citation

    1. Nussbaum SR, Younger J, VandePol CJ, et al: Single-dose intravenous therapy with pamidronate for the treatment of hypercalemia of malignancy: Comparison of 30-, 60-, and 90-mg dosages. American Journal of Medicine 1993; 95: 297-304
    Contributor: Clare Wotton and Musab Hayatli, June 2000
    Reviewer:

    Clinical Question.
    Patient hypercalcaemia of malignancy
    Intervention or Exposure pamidronate
    Outcome normocalcaemianormocalcemia