Therapy

Give pamidronate ^a 90 mg over 1 hour intravenously ^a

Why?

• It speeds return to normocalcaemia and reduces relapse ^a  
• Fever is a common side-effect ^a  
• 90 mg of pamidronate is more effective than 30 or 60 mg ^a  
• It is more effective than etidronate ^a , clondronate, and mithramycin ^a and the effects lasts longer (on average 2 weeks ^a  

90 mg of pamidronate helps correct hypercalcaemia and prevents relapse

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
hypercalcaemia a	pamidronate	placebo	normocalcaemia at 7 days	22%	-220% (-611% to -44%)	2 (1 to 4)
			fever due to medication at 7 days	0.0%		-5 (-10 to -3)
			relapse (following normocalcaemia ) at 7 days	91%	43% (23% to 58%)	3 (2 to 5)
hypercalcaemia a	pamidronate 90 mg iv	pamidronate 60 mg iv	normocalcaemia	100%	-64% (-137% to -13%)	3 (2 to 6)
hypercalcaemia a	pamidronate	etidronate	normocalcaemia at 7 days	40%	-75% (-180% to -10%)	3 (2 to 14)
hypercalcaemia a	pamidronate	clondronate	normocalcaemia at 7 days	80%	-25% (-56% to 0%)	5 (3 to 40)
hypercalcaemia a	pamidronate	mithramycin	normocalcaemia at 9 days	86%	-270% (-860% to -40%)	1 (1 to 2)