http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
( Andrew Huynh ),( Scott Baker ),( Andrew Stewardson ),( Douglas Johnson ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Denosumab, a humanised monoclonal antibody against receptor activator of nuclear factor kappa beta ligand (RANKL), reduces bone turnover via inhibition of osteoclasts and osteoclastogenesis and is used in the management of osteoporosis and metastatic bone disease. While hypocalcaemia complicating denosumab treatment has been reported, the real world incidence, clinical and biochemical risk factors are not fully elucidated. This study aims to investigate the incidence of denosumab-associated hypocalcaemia (DAH) and identify relevant clinical and investigation features. Methods: We performed a retrospective observational audit of patients administered denosumab (60mg/120mg) over a 12 month period at a tertiary hospital in Australia. Data collected: denosumab dosage and indication, 25-hydroxyvitamin D concentration, parathyroid hormone, estimated glomerular filtration rate (eGFR), nadir and duration of hypocalcaemia (albumin adjusted serum calcium concentration <2.15 mmol/L or ionised calcium <1.13 mmol/L upto 6 months post denosumab administration), calcium and colecalciferol pre- and post-administration of denosumab. The primary outcome was the incidence proportion of DAH. Results: Of 161 patients administered denosumab (106 osteoporosis, 55 bone metastases), 20 patients (12.4%, mean age 78.5 years, 11 male, 11 osteoporosis, 9 bone metastases) developed hypocalcaemia. Median calcium nadir was 2.06 mmol/L (interquartile range (IQR) 1.81-2.11), with the median time to diagnosis 24.50 days (IQR 9.25-41.25). One patient required intravenous calcium gluconate treatment. 75% of affected patients had a 25-hydroxyvitamin D concentration >50nmol/L and 90% of affected patients were on calcium or colecalciferol supplementation. DAH was associated with sex (27% males versus 8% females, p=0.004), but not age (8% under 60 years versus 13% aged 60 or more, p=0.74) or indication (16% with bone metastases versus 10% with osteoporosis, p=0.32). Conclusions: Denosumab-associated hypocalcaemia occurred in over 12% of patients in this population, despite wide use of appropriate calcium and colecalciferol supplementation.