Hypercalcaemia: pamidronate and clodronate achieved normocalcaemia.

Clinical bottom line (level 1b)

  1. In patients with hypercalcaemia of malignancy, pamidronate and clodronate were both effective in achieving normocalcaemia, but pamidronate may be slightly superior.
Purohit et al: British Journal of Cancer 1995; 72: 1289-1293
Expires June 2003

The study

Double-blinded concealed randomised trial without intention-to-treat
Setting: general hospital, UK

41 patients (aged ?, ?% male) hypercalcaemia (adjusted serum calcium >2.7 mmol/l) of malignancy

Excluded if

Control Group: (n = 20, 19 analysed): pamidronate 90 mg in 500 ml of normal saline over 4 hours
Experimental Group: (n = 21, 20 analysed): clodronate 1500 mg administered in 500 ml of normal saline over 4 hours
Intravenous hydration was continued until normocalcaemia.
95% followed for 28 days

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNH
(95% CI)
did not achieve normocalcaemia unknown 0
(0.00%)		 4
(20.0%)		 %
(% to %)		 -20.0%
(-37.5% to -2.47%)		 5
(3 to 40)

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
median duration of normocalcaemia (days) 28 (range 10-28+)
() 		14 (range 7-21)
() 		14
( to )
post-hydration serum calcium 3.17
() 		3.06
() 		0.11
( to )

  • The median time to normocalcaemia was 3 days in the clodronate group and 4 days in the pamidronate group.

    • Citation

    1. Purohit OP, Radstone CR, Anthony C, et al: A randomised double-blind comparison of intravenous pamidronate and clodronate in the hypercalcaemia of malignancy. British Journal of Cancer 1995; 72: 1289-1293
    Contributor: Clare Wotton and Musab Hayatli, June 2000
    Reviewer:

    Clinical Question.
    Patient Hypercalcemia Hypercalcaemiaof malignancy
    Intervention or Exposure pamidronate
    Comparison clodronate
    Outcome Normocalcemia Normocalcaemia