Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy
Background Hypercalcemia of malignancy (HCM), a major metabolic complication of cancer, is often managed with bisphosphonates (BP) and, increasingly, with denosumab. We aimed to compare the effectiveness and safety of denosumab with that of BP, with or without calcitonin, in treating HCM. Methods Th...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Endocrine Society
2025-04-01
|
| Series: | Endocrinology and Metabolism |
| Subjects: | |
| Online Access: | http://e-enm.org/upload/pdf/enm-2024-2132.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850258378065969152 |
|---|---|
| author | Sung Hye Kong Seung Shin Park Jung Hee Kim Sang Wan Kim Se Hyun Kim Jee Hyun Kim Chan Soo Shin |
| author_facet | Sung Hye Kong Seung Shin Park Jung Hee Kim Sang Wan Kim Se Hyun Kim Jee Hyun Kim Chan Soo Shin |
| author_sort | Sung Hye Kong |
| collection | DOAJ |
| description | Background Hypercalcemia of malignancy (HCM), a major metabolic complication of cancer, is often managed with bisphosphonates (BP) and, increasingly, with denosumab. We aimed to compare the effectiveness and safety of denosumab with that of BP, with or without calcitonin, in treating HCM. Methods This retrospective cohort study was conducted at a tertiary hospital from 2017 to 2022 and included 317 patients treated for HCM. Participants were divided into three treatment groups: denosumab, intravenous (IV) BP only, and IV BP combined with calcitonin. The primary outcomes measured were changes in calcium levels and the incidence of hypocalcemia. Analysis of covariance was used to adjust for age, sex, body mass index, creatinine level, type of malignancy, and the use of furosemide and steroids. Results The mean participant age was 65 years, and 37.5% were female. After adjustment, both denosumab and IV BPs were found to effectively lower calcium levels. Denosumab led to a decrease of 2.0 mg/dL (−15.9%), while IV BP alone resulted in a reduction of 1.8 mg/dL (−13.9%). The largest reduction, of 2.7 mg/dL (−20.9%), occurred with IV BP and calcitonin. Both denosumab and IV BP+calcitonin yielded their lowest calcium levels within 48 hours, whereas the IV BP only group reached a nadir within 72 hours. Despite these differences in treatment effectiveness, hypocalcemia occurred significantly less frequently in the denosumab group compared to the other groups. Conclusion Denosumab and IV BP were similarly effective in reducing calcium levels. However, IV BP combined with calcitonin yielded a more rapid and pronounced decrease. |
| format | Article |
| id | doaj-art-c96d3722fe034691b702fcbc4e9b52d9 |
| institution | OA Journals |
| issn | 2093-596X 2093-5978 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Korean Endocrine Society |
| record_format | Article |
| series | Endocrinology and Metabolism |
| spelling | doaj-art-c96d3722fe034691b702fcbc4e9b52d92025-08-20T01:56:10ZengKorean Endocrine SocietyEndocrinology and Metabolism2093-596X2093-59782025-04-0140228929810.3803/EnM.2024.21322577Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of MalignancySung Hye Kong0Seung Shin Park1Jung Hee Kim2Sang Wan Kim3Se Hyun Kim4Jee Hyun Kim5Chan Soo Shin6 Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, KoreaBackground Hypercalcemia of malignancy (HCM), a major metabolic complication of cancer, is often managed with bisphosphonates (BP) and, increasingly, with denosumab. We aimed to compare the effectiveness and safety of denosumab with that of BP, with or without calcitonin, in treating HCM. Methods This retrospective cohort study was conducted at a tertiary hospital from 2017 to 2022 and included 317 patients treated for HCM. Participants were divided into three treatment groups: denosumab, intravenous (IV) BP only, and IV BP combined with calcitonin. The primary outcomes measured were changes in calcium levels and the incidence of hypocalcemia. Analysis of covariance was used to adjust for age, sex, body mass index, creatinine level, type of malignancy, and the use of furosemide and steroids. Results The mean participant age was 65 years, and 37.5% were female. After adjustment, both denosumab and IV BPs were found to effectively lower calcium levels. Denosumab led to a decrease of 2.0 mg/dL (−15.9%), while IV BP alone resulted in a reduction of 1.8 mg/dL (−13.9%). The largest reduction, of 2.7 mg/dL (−20.9%), occurred with IV BP and calcitonin. Both denosumab and IV BP+calcitonin yielded their lowest calcium levels within 48 hours, whereas the IV BP only group reached a nadir within 72 hours. Despite these differences in treatment effectiveness, hypocalcemia occurred significantly less frequently in the denosumab group compared to the other groups. Conclusion Denosumab and IV BP were similarly effective in reducing calcium levels. However, IV BP combined with calcitonin yielded a more rapid and pronounced decrease.http://e-enm.org/upload/pdf/enm-2024-2132.pdfcalcitonindenosumabdiphosphonateshypercalcemiasafetytreatment outcome |
| spellingShingle | Sung Hye Kong Seung Shin Park Jung Hee Kim Sang Wan Kim Se Hyun Kim Jee Hyun Kim Chan Soo Shin Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy Endocrinology and Metabolism calcitonin denosumab diphosphonates hypercalcemia safety treatment outcome |
| title | Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy |
| title_full | Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy |
| title_fullStr | Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy |
| title_full_unstemmed | Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy |
| title_short | Comparison of the Effectiveness and Hypocalcemia Risk of Antiresorptive Agents in Patients with Hypercalcemia of Malignancy |
| title_sort | comparison of the effectiveness and hypocalcemia risk of antiresorptive agents in patients with hypercalcemia of malignancy |
| topic | calcitonin denosumab diphosphonates hypercalcemia safety treatment outcome |
| url | http://e-enm.org/upload/pdf/enm-2024-2132.pdf |
| work_keys_str_mv | AT sunghyekong comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy AT seungshinpark comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy AT jungheekim comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy AT sangwankim comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy AT sehyunkim comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy AT jeehyunkim comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy AT chansooshin comparisonoftheeffectivenessandhypocalcemiariskofantiresorptiveagentsinpatientswithhypercalcemiaofmalignancy |