Difference of Acute Phase Response According to the Route of Bisphosphonate Administration

초록

Introduction Bisphosphonates (BPs) have two ways of administration, oral and intravenous (IV) methods. Although acute phase response (APR) becomes a problem in intermittent large dose BP the effect on APR by different route of administration has not been yet studied. Objective We analyzed the difference of APR after administration of oral and IV BP. Methods Twenty six patients were given 30mg of IV pamidronate (pamidronate group) whereas ten patients took oral ibandronate 150mg (ibandronate group). Serum calcium level and hematologic parameter such as White Blood Cell (WBC) count were determined at baseline and 48 hours. Acute phase reactants including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured at baseline, 24, 48, 72 hours and a week after administration. Results Both group showed significantly lowered serum calcium level at 48 hours after administration (p=0.02 in pamidronate group, p=0.008 in ibandronate group). Both group failed to show marked effect on WBC count for 2 days after therapy. However WBC count was found to be significantly lowered in ibandronate group after 7 days of medication (p= 0.021). The number of granulocyte decreased significantly (p=0.011) whereas the lymphocyte count did not change. The basal CRP level was 0.13 ± 0.1 mg/dL which rose to 0.26 ± 0.3 mg/dL at 24 hours, 0.55 ± 0.73 mg/dL at 48 hours, 1.33 ± 2.7 mg/dL at 72 hours and its rise was significant (p = 0.026). Conclusion This study showed that both BPs decreased serum calcium level despite supplemental calcium intake. Monthly oral ibandronate decreased peripheral WBC count a week later, suggesting that oral medication may cause delayed side effect. Increase in acute phase reactants was prominent after pamidronate administration. Therefore more attention should be required for early APR when IV BP is administered and delayed side effects should be reminded when intermittent large dose oral BP is taken.