Patient-reported effectiveness and safety of Pamidronate in NSAIDs-refractory chronic recurrent multifocal osteomyelitis in children

Bartłomiej Juszczak,Jerzy Sułko

doi:10.1007/s00296-021-04886-4

Abstract

To evaluate patient-reported effectiveness, safety and social influence of Pamidronate in the therapy of NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis in children. Authors reviewed self-created questionnaires, which asked patients for symptoms alleviation, adverse drug reactions frequency and degree of severity and daily activities self-reliance. Only surveys with complete answers, which were returned to authors by an e-mail from juvenile patients treated for NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis at the University Children’s Hospital of Cracow were analyzed. Between 2010 and 2019, 61 children were diagnosed with NSAIDs-refractory Chronic Recurrent Multifocal Osteomyelitis at our department. Out of 61 requests sent, 42 complete replies (33 females, 9 males) were gathered and analyzed. All patients included in this research were administered with at least one set of Pamidronate intravenously in the dose of 1 mg/kg/day for 3 consecutive days. Our analysis shows remarkable in terms of patient’s impressions decrease of pain intensity after 2.5 series of Pamidronate on average, and total pain resolution after 5.9 series on average. Overall number of adverse drug reaction events reported by responders was 105. One patient developed drug-dependent renal insufficiency in the course of therapy. Outcome assessment indicates that nearly 50% of the studied population was more eager to participate in social life just after the first infusion of the drug. 95% of the surveyed unanimously agreed to recommend Pamidronate therapy to cure NSAIDs-refractory CRMO. 39 out of 42 (93%) patients considered Pamidronate effective at the end of the treatment. Onset of Pamidronate’s action is gradual and differs in terms of symptoms alleviation between sexes. The therapy can induce considerable number of adverse drug reactions (2.5 per patient). Only 3 out of 42 (7%) patients were free from any ADRs. To demonstrate the impact of the use of Pamidronate on daily activities more precisely, further research with quantification of the quality of life is warranted.

Highlights

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an inflammatory, yet non-infectious disease that presents itself with pain, fever and enlargement of affected bones
Taking into account these limitations, the authors of this paper conducted research on a larger group of pediatric patients diagnosed with NSAIDsrefractory CRMO, who were treated with successive infusions of Pamidronate
Pamidronate is considered very effective in restoring normal functions of the musculoskeletal system by patients; it is burdened with a high risk of adverse drug reactions

Summary

Introduction

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an inflammatory, yet non-infectious disease that presents itself with pain, fever and enlargement of affected bones. It was first reported by Giedon [1] as “symmetrical” lesions of osteomyelitis. The evidence on bisphosphonates efficacy in CRMO treatment is based on small population groups [13,14,15], which undermines their efficiency and safety. Taking into account these limitations, the authors of this paper conducted research on a larger group of pediatric patients diagnosed with NSAIDsrefractory CRMO, who were treated with successive infusions of Pamidronate

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