PAMIDRONATE INFUSIONS FOR THE TREATMENT OF PAGETS-DISEASE OF BONE - VALUE OF A RETURN TO NORMAL OF ALKALINE-PHOSPHATASE LEVELS

Effective pamidronate dosages in Paget's disease of bone have not yet been determined. We prospectively compared two pamidronate dosages (60 mg and 120 mg) in 26 patients whose baseline alkaline phosphatase lev el was at least two-fold the upper limit of normal, Pamidronate was gi ven as three-hour infusions of 60 mg each, Follow-up was two years, Th e two groups were comparable at baseline except for higher alkaline ph osphatase and hydroxyproline levels in the group treated with 120 mg p amidronate, Efficacy on laboratory parameters was greater in the highe r dosage group, Osteocalcin levels showed little change, In both dosag e groups, alkaline phosphatase levels fell significantly versus baseli ne, and the difference persisted throughout the two-year follow-up, Ur inary hydroxyproline excretion remained significantly reduced versus b aseline during the first 12 months and rose subsequently, A return to normal of the two study parameters six months after treatment was asso ciated with longer duration of the biologic treatment response, A surv ival curve analysis confirmed this finding and suggested that a return to normal of laboratory parameters was predictive of clinical remissi on, The drug was well tolerated, Adverse effects were mild and similar to those recorded during earlier studies.