Ibandronate To Treat Skeletal-related Events And Bone Pain In Metastatic Bone Disease Or Multiple Myeloma:A Meta-analysis Of Randomized Clinical Trial

Aim:Randomized controlled trials (RCTs) have given contradictory results about the efficacy and safety of ibandronate in treating metastatic bone disease (MBD) or multiple myeloma. This review meta-analyzed the literature to gain a more comprehensive picture.Methods:PubMed, EMBASE, and the Cochrane Library databases were systematically searched to identify RCTs evaluating ibandronate to treat MBD or multiple myeloma. Relative risk ratios (RRs) or weighted mean differences (WMDs) were calculated together with 95% confidence intervals (CIs).Results:Ten RCTs involving 3,474 patients were included. Intravenous ibandronate (6 mg) or oral drug (50 mg) decreased the risk of skeletal-related events compared to placebo (RR 0.80,95% CI 0.71 to 0.90, P= 0.002). It also reduced the bone pain score below baseline significantly more than did placebo at 96 weeks (WMD-0.41,95% CI-0.56 to-0.27, P<0.001).The incidence of diarrhea was similar between the ibandronate and placebo groups (RR 2.05, 95% CI 0.85 to 4.95, P=0.11). The incidence of renal adverse events was also similar between the ibandronate and placebo groups (RR 1.14,95% CI 0.59 to 2.21, P= 0.69), but ibandronate was associated with greater risk of abdominal pain (RR 2.26,95% CI 1.09 to 4.70, P=0.03; I2=7%). Ibandronate was associated with similar risk of skeletal-related events as another bisphosphonate drug, zoledronate (RR 1.02,95% CI 0.82 to 1.26, P=0.87). The incidence of nausea, jaw osteonecrosis, fatigue was similar for the two drugs, but the incidence of adverse renal events was significantly lower in the ibandronate group (RR 0.74,95% CI 0.63 to 0.88, P=0.006; I2=9%). The incidence of fever or influenza symptoms was slightly lower than zoledronate (RR 0.47, 95%CI 0.22 to 1.01, P=0.05; I2=80%).Conclusion:Ibandronate significantly reduce the incidence of skeletal-related events and bone pain in patients with MBD or multiple myeloma relative to placebo. It is also associated with a similar incidence of skeletal-related events as zoledronate.