Comparison of oral and intravenous ibandronate on acute phase response in osteoporotic patients

초록

Introduction Ibandronate may be administered in two ways, via either oral or intravenous (IV) routes. Although acute phase response (APR) is expected to be prominent in intravenous regimen than oral route, it was not yet studied in osteoporotic patients. Objective We analyzed the difference of APR after administration of oral and IV ibandronate. Methods Total of twenty one osteoporotic patients was enrolled. Sixteen patients took 150mg of oral ibandronate (oral group) whereas eight patients were given IV ibandronate 3mg (IV group). Acute phase reactants including ESR and CRP were measured at baseline, 1, 2, 3 and 7 days after administration. Serum tumor necrosis (TNF)- α level was assessed using an immunoenzymetric assay (TNF- α: R&D Systems, Minneapolis, Minn., USA). Serum calcium level and hematologic parameter such as differential WBC count were also done. Results Intravenous group showed significant rise in serum CRP level during initial 2 days (p = 0.021, 0.036 at 24 and 48 hours, respectively) as oral group showed modest increase. There was no marked change in ESR between two groups. Serum TNF elevation was not significant in both groups. Serum calcium level decreased significantly for 2 days after oral ibandronate administration (p = 0.003, 0.003 at day 1 and day 2) while it was slight in IV group. Neither groups showed any significant change on hematologic parameters. Conclusion This study proved that acute phase response is prominent after intravenous administration. Therefore more attention is required for early APR when IV BP is administered and attention for serum calcium level after both IV and oral intermittent large dose bisphosphonate regimen should be taken.