why is Zometa used for multiple myeloma and not Reclast, when both are zoledronic acid?
Zometa's strength is 4mg/5ml (highly concentrated) vs. Reclast which is 5mg/100ml.
We know that the side effects of bisphosphonates are cummulative based on dosage.
And that patients on Reclast do not have the same incidence of osteonecrosis of the jaw.
Also Reclast is given annually or 2x a year.
Why do multiple myeloma patients get Zometa monthly and use the highly concentrated formulation?
Especially given the frequency of side effects are dose cummulative?
Forums
Re: Zometa vs Reclast
Hi Suzierose, I read an article somewhere that Zometa actually does more than protect one's bones. Researchers think it actually has an anti-cancer effect that they don't fully understand. Apparently, Reclast does not provide the same benefits inaddition to protecting the bones.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Zometa vs Reclast
Thanks Terry,
That is really confounding since they are the exact same chemical. The only difference is concentration.
The drugs have different indiciations, though:
Zometa® is indicated for (1) hypercalcemia of malignancy and (2) multiple myeloma and bone metastases of solid tumors.[4] Reclast® is indicated for (1) treatment of osteoporosis in postmenopausal women, (2) prevention of osteoporosis in postmenopausal women, (3) treatment of osteoporosis in men, (4) treatment and prevention of glucocorticoid-induced osteoporosis, and (5) treatment of Paget's disease of bone.[5]
And the other interesting thing is that Zometa 4 mg was found to be suboptimal dose in over a third of patients in a 5 year study.
"Detailed analysis of bone marker changes, however, suggests that this drug regimen causes insufficient reduction of remodelling activity in one third of patients."
http://www.medscape.com/medline/abstract/17516022
All of this is very confounding.
That is really confounding since they are the exact same chemical. The only difference is concentration.
The drugs have different indiciations, though:
Zometa® is indicated for (1) hypercalcemia of malignancy and (2) multiple myeloma and bone metastases of solid tumors.[4] Reclast® is indicated for (1) treatment of osteoporosis in postmenopausal women, (2) prevention of osteoporosis in postmenopausal women, (3) treatment of osteoporosis in men, (4) treatment and prevention of glucocorticoid-induced osteoporosis, and (5) treatment of Paget's disease of bone.[5]
And the other interesting thing is that Zometa 4 mg was found to be suboptimal dose in over a third of patients in a 5 year study.
"Detailed analysis of bone marker changes, however, suggests that this drug regimen causes insufficient reduction of remodelling activity in one third of patients."
http://www.medscape.com/medline/abstract/17516022
All of this is very confounding.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Zometa vs Reclast (and Aredia)
I have a question on this topic, too. I've just had my 2nd SCT after a 6 yr remission. On my first Induction in 2005, I was given Zometa.
On the induction for the 2nd transplant, I was given Aredia, ostensibly because it reduced the incidence of jaw necrosis.
An oncologist outside my healthcare provider told me Aredia was inferior to Zometa, and was probably recommended because it was cheaper. Any truth to this, and what's the difference between the two?
Thanks in advance.
Jon
On the induction for the 2nd transplant, I was given Aredia, ostensibly because it reduced the incidence of jaw necrosis.
An oncologist outside my healthcare provider told me Aredia was inferior to Zometa, and was probably recommended because it was cheaper. Any truth to this, and what's the difference between the two?
Thanks in advance.
Jon
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Jon - Name: Jon
- When were you/they diagnosed?: mar 2005
- Age at diagnosis: 60
Re: Zometa vs Reclast
I don't know about pricing
but Aredia is pamidronate disodium and
has not been shown to be as effective as zoledronic acid.
However while it is a different chemical it still belongs to the class of drugs known as biphosphates..which means that like zoledronic acid, osteonecrosis of the jaw has been reported in patients on Aredia.
but Aredia is pamidronate disodium and
has not been shown to be as effective as zoledronic acid.
However while it is a different chemical it still belongs to the class of drugs known as biphosphates..which means that like zoledronic acid, osteonecrosis of the jaw has been reported in patients on Aredia.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Zometa vs Reclast
Hey Terri,
Finally discovered what you meant.
It was not Reclast you were talking about but pamidronate!
You are exactly right AREDIA (pamidronate) does not confer the additional anti-cancer protections that ZOMETA (zoledronic acid) does. Pamidronate is a different structure but still a bisphosphanate, unlike Reclast, which is same chemical structure as Zometa.
Thanks for your feedback...it made me think and search more.
Finally discovered what you meant.
It was not Reclast you were talking about but pamidronate!
You are exactly right AREDIA (pamidronate) does not confer the additional anti-cancer protections that ZOMETA (zoledronic acid) does. Pamidronate is a different structure but still a bisphosphanate, unlike Reclast, which is same chemical structure as Zometa.
Thanks for your feedback...it made me think and search more.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Zometa vs Reclast
Hi suzierose,
Can you explain what basis there is for your statement that Aredia doesn't offer the same anti-cancer (anti-myeloma?) benefit as Zometa?
My understanding is that Aredia and Zometa have never been tested head-to-head to see if one has more or less anti-myeloma effect compared to the other.
Instead, Zometa has been tested head-to-head against a weak bisphosphonate not even sold here in the U.S. (Bonefos), and found to have a survival benefit versus Bonefos.
But, as I said, I don't think there are any head-to-head studies comparing Aredia and Zometa.
This is more important than it seems, because there is a lot of money at stake. Aredia is available as a generic, which means it is really cheap. Zometa is not available in generic form.
Doesn't it make you suspicious that the company that sells Zometa, when it sponsored the trial that tested Zometa vs. Bonefos, specifically chose Bonefos, rather than the stronger -- and more widely used -- Aredia, as the drug to test Zometa against?
Finally, I don't think it is "settled science" that Zometa, or the bisphosphonates more broadly, have a true anti-myeloma effect. They definitely seem to be beneficial to myeloma patients. The NCCN guidelines now recommend that basically all myeloma patients be treated with bisphosphonates. That doesn't mean, though, that the drugs actually kill myeloma cells, which is what you would expect from a true "anti-myeloma" drug.
Sorry that I'm jumping in late into this discussion. I saw it a while back, but didn't have the time to pipe in then. It's a good one, and I'm glad the topic is being discussed.
Can you explain what basis there is for your statement that Aredia doesn't offer the same anti-cancer (anti-myeloma?) benefit as Zometa?
My understanding is that Aredia and Zometa have never been tested head-to-head to see if one has more or less anti-myeloma effect compared to the other.
Instead, Zometa has been tested head-to-head against a weak bisphosphonate not even sold here in the U.S. (Bonefos), and found to have a survival benefit versus Bonefos.
But, as I said, I don't think there are any head-to-head studies comparing Aredia and Zometa.
This is more important than it seems, because there is a lot of money at stake. Aredia is available as a generic, which means it is really cheap. Zometa is not available in generic form.
Doesn't it make you suspicious that the company that sells Zometa, when it sponsored the trial that tested Zometa vs. Bonefos, specifically chose Bonefos, rather than the stronger -- and more widely used -- Aredia, as the drug to test Zometa against?
Finally, I don't think it is "settled science" that Zometa, or the bisphosphonates more broadly, have a true anti-myeloma effect. They definitely seem to be beneficial to myeloma patients. The NCCN guidelines now recommend that basically all myeloma patients be treated with bisphosphonates. That doesn't mean, though, that the drugs actually kill myeloma cells, which is what you would expect from a true "anti-myeloma" drug.
Sorry that I'm jumping in late into this discussion. I saw it a while back, but didn't have the time to pipe in then. It's a good one, and I'm glad the topic is being discussed.
Re: Zometa vs Reclast
Also, on the question of whether it makes any difference if you get Reclast or Zometa, I'm pretty sure it doesn't. The active ingredient of both drugs is exactly the same -- zoledronic acid. The company that developed the drug, Novartis, has played the "give the same drug different names for different uses" game in a number of cases. For example, its drugs "Zortress" and "Afinitor" both have the same active ingredient, but its sold under the different names because they have different target uses. I wouldn't be surprised if the drugs also have rather different prices, even though they have the same active ingredient.
All I can say is, when a company plays those sorts of games, it should make you stop and think a bit more critically about what you should believe about its drugs.
All I can say is, when a company plays those sorts of games, it should make you stop and think a bit more critically about what you should believe about its drugs.
Re: Zometa vs Reclast
Hi Terry!
This is the study, that gave the information about the superiority of zoledronic acid vs. pamidronate.
http://jco.ascopubs.org/content/19/2/558.full
You are absolutely correct it is not head to head, but when the pharma industry refuses to cooperate and sponsor a head to head...then we do the next best thing...compare to trials of the agents:
"Two identical, concurrent, parallel, multicenter, randomized, double-blind, double-dummy trials were conducted at centers in the UnitedStates/CanadaEurope/Australia....This study represents the largest prospective, randomized, comparative, clinical trial ever conducted between two bisphosphonates in HCM or other disease states.
http://jco.ascopubs.org/content/19/2/558.full
With regard to anti myeloma? haven't seen that stated, I used the same your wording as you regarding anti-tumor (cancer) synergism:
"Coleman et al (2010) noted that pre-clinical studies have demonstrated synergistic anti-tumor effects of chemotherapy (CT) and zoledronic acid (ZOL). Within the AZURE trial, designed to determine whether the addition of ZOL to neoadjuvant therapy improves disease outcomes"
Look at BACKGROUND section:
http://www.aetna.com/cpb/medical/data/500_599/0524.html
With regard to 'settled science"..it may not be conclusive..however I don't know why an insurance company would be citing all this data, if they did not consider it 'settled' enough to pay for.
No, I am not suspicious of pharma, I know that is how they operate. Why do a head to head, if you could lose, it's like poker., they know when to fold 'em. They have nothing to gain and everything to lose when it comes to their profit margins...and they will have financed their own demise by providing the drug, lol.
As for being late, naw...you had confounded me, which made me search for more data, when you said Reclast had anti-cancer effects and I knew they were same compound...then I found the data on Aredia, pamidronate....You're not jumping in late..you came to the party early and are just now getting back!!
This is the study, that gave the information about the superiority of zoledronic acid vs. pamidronate.
http://jco.ascopubs.org/content/19/2/558.full
You are absolutely correct it is not head to head, but when the pharma industry refuses to cooperate and sponsor a head to head...then we do the next best thing...compare to trials of the agents:
"Two identical, concurrent, parallel, multicenter, randomized, double-blind, double-dummy trials were conducted at centers in the UnitedStates/CanadaEurope/Australia....This study represents the largest prospective, randomized, comparative, clinical trial ever conducted between two bisphosphonates in HCM or other disease states.
http://jco.ascopubs.org/content/19/2/558.full
With regard to anti myeloma? haven't seen that stated, I used the same your wording as you regarding anti-tumor (cancer) synergism:
"Coleman et al (2010) noted that pre-clinical studies have demonstrated synergistic anti-tumor effects of chemotherapy (CT) and zoledronic acid (ZOL). Within the AZURE trial, designed to determine whether the addition of ZOL to neoadjuvant therapy improves disease outcomes"
Look at BACKGROUND section:
http://www.aetna.com/cpb/medical/data/500_599/0524.html
With regard to 'settled science"..it may not be conclusive..however I don't know why an insurance company would be citing all this data, if they did not consider it 'settled' enough to pay for.
No, I am not suspicious of pharma, I know that is how they operate. Why do a head to head, if you could lose, it's like poker., they know when to fold 'em. They have nothing to gain and everything to lose when it comes to their profit margins...and they will have financed their own demise by providing the drug, lol.
As for being late, naw...you had confounded me, which made me search for more data, when you said Reclast had anti-cancer effects and I knew they were same compound...then I found the data on Aredia, pamidronate....You're not jumping in late..you came to the party early and are just now getting back!!
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Zometa vs Reclast
Terry
With regards to Reclast vs. Zometa, I too think it should not make a difference, except Zometa is 20 times as concentrated and can be given in 15min infusion monthly. Maybe, that makes a cost difference?
Can't see how given that Reclast is given every 3 months.
Perhaps, it is as simple as having a less concentrated admixture for pharmacy for non-cancer patients.
My real question was about the ONJ adverse event..since the incidence is lower with Reclast vs.
Zometa.
However, in the subset population of chemo patients, ONJ with Zometa is higher than the incidence for non-chemo patients anyway.
I still don't know why chemo patients need a much higher concentration...that is the real question.
BTW, companies commonly market their drugs under multiple names in different countries..not uncommon at all. And with an agent like Reclast vs. Zometa, it is better for the pharmacy in terms of making an error if the drugs have different names, since one is 20x more concentrated. That would be a huge error for an osteoporosis patient to receive Zometa vs. Reclast.
With regards to Reclast vs. Zometa, I too think it should not make a difference, except Zometa is 20 times as concentrated and can be given in 15min infusion monthly. Maybe, that makes a cost difference?
Can't see how given that Reclast is given every 3 months.
Perhaps, it is as simple as having a less concentrated admixture for pharmacy for non-cancer patients.
My real question was about the ONJ adverse event..since the incidence is lower with Reclast vs.
Zometa.
However, in the subset population of chemo patients, ONJ with Zometa is higher than the incidence for non-chemo patients anyway.
I still don't know why chemo patients need a much higher concentration...that is the real question.
BTW, companies commonly market their drugs under multiple names in different countries..not uncommon at all. And with an agent like Reclast vs. Zometa, it is better for the pharmacy in terms of making an error if the drugs have different names, since one is 20x more concentrated. That would be a huge error for an osteoporosis patient to receive Zometa vs. Reclast.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
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