Addition of dexamethasone to manage acute phase responses following initial zoledronic acid infusion

Chen, F.-P.<sup>1,2,3</sup>; Fu, T.-S.<sup>1,4</sup>; Lin, Y.-C.<sup>1,5</sup>; Lin, Y.-J.<sup>6</sup>

Affiliations

¹Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan

²Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital, 222 Mai-Chin Rd., Keelung 204, Taiwan

³Department of Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 259, Taiwan

⁴Department of Orthopaedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan

⁵Department of Radiology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan

⁶Research Service Center for Health Information, Chang Gung University, Tao-Yuan 259, Taiwan

Abstract and keywords

Summary: Acute phase response (APR), including myalgia, influenza-like symptoms, headache, arthralgia, and pyrexia, is the most common adverse reaction to initial zoledronic acid infusion. Dexamethasone plus acetaminophen is effective in significantly reducing the incidence and severity of APR.

Introduction: Acute phase response (APR), including myalgia, influenza-like symptoms, headache, arthralgia, and pyrexia, is due to immunomodulatory actions and is the most common adverse reaction to zoledronic acid (ZOL). The aims of our study were to compare the differences between acetaminophen and dexamethasone plus acetaminophen on the incidence and severity of APRs and to clarify the clinical factors related to APR with initial ZOL infusion.

Methods: Patients with osteoporosis receiving their first ZOL infusion (N = 96) were assigned into two groups and given either acetaminophen (58 patients, control group) or acetaminophen plus dexamethasone (38 patients, study group). APRs were assessed through telephone interviews 2 weeks later post-infusion. Clinical, demographic, and serologic data were recorded.

Results: There was a significant increase in the incidence and severity of any APR in the control group than the study group (67% vs. 34%, p = 0.003; 0.69 ± 0.50 vs. 0.34 ± 0.48, p = 0.001). Among the APRs, only myalgia incidence and score were significantly higher in the control group than in the study group. Multivariate analysis demonstrated that previous use of osteoporosis medication and participation in the study group was negatively related to the occurrence of any APR or myalgia. Advanced age was shown to significantly increase myalgia. Study group participants had significantly reduced severity of myalgia. The adherence for redosing ZOL was significantly higher in the study group.

Conclusion: Dexamethasone plus acetaminophen is effective in significantly reducing the incidence and severity of APR, especially myalgia, and increasing adherence following initial ZOL infusion.

Keywords: Acetaminophen; Acute phase response; Dexamethasone; Myalgia; Pyrexia; Zoledronic acid

Links

DOI: 10.1007/s00198-020-05653-0

PubMed: 33113007

WoS: 000584890200001

History

Received: 2020-06-24

Accepted: 2020-09-22

Online: 2020-10-28

Cited Works (1)

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Cited By (1)

Year	Entry
2023	Murdoch R, Mellar A, Horne AM, Billington E, Chan PL, Gamble GD, Reid IR. Effect of a three-day course of dexamethasone on acute phase response following treatment with zoledronate: a randomized controlled trial. J Bone Miner Res. May 2023;38(5):631-638.