双膦酸盐不良反应文献报告ppt课件.ppt

3. 分析与讨论 依替膦酸盐是第1代双膦酸盐类药物，但由于其疗效差、毒副作用大，应用已逐渐减少；之后的第2代双膦酸盐类药物包括替鲁膦酸盐、氯膦酸盐、帕米膦酸盐等，其中帕米膦酸盐综合评价较氯膦酸盐好；第三代在安全性和疗效方面更佳，主要有阿仑膦酸盐、依班膦酸盐、利塞膦酸盐及唑来膦酸等。本类药物对骨的最终作用是相同的，但在物理、化学、生物及毒理学上各不相同。分析文献资料及目前循证医学证据，双膦酸盐的不良反应主要有低钙血症、一过性急性期反应、颌骨坏死、肾脏毒性，还有胃肠道反应、眼部不适、肾毒性、颚骨坏死、肌肉骨骼疼痛等。 权衡双膦酸盐的获益和风险 获益 风险 骨相关事件减少 生存时间延长 少见，可管理 颌骨坏死 肾功能影响 双磷酸盐 3 分析与评论 4. 小结 双膦酸盐类药物用于治疗肿瘤骨转移的重要地位是无庸置疑的。但与此类药物相关的某些严重不良反应会给治疗带来困难，从而影响了其在临床使用过程中的连续性和患者对该类药物的依从性。因此临床医师及药师应关注双膦酸盐类药物的不良反应及防治策略，做好患者的药学监护及用药教育，使双膦酸盐类药物的使用更为合理、安全、有效，从而提高患者的生活质量。 参考文献 [1] Aapro M , et al. Guidance on the use of bisphosphonates in solid tumours:recommendations of an international expert panel [J]. Annals of Oncology 2008, 19: 420-432. [2] Gómez Font R, Martínez García ML, Olmos Martínez JM. Osteochemonecrosis of the jaws due to bisphosphonate treatments [J]. Med Oral Patol Oral Cir Bucal. 2008, 13 (5): E318-324. [3] Yanik B, Bavbek N, Yanik T,et al. The effect of alendronate, risedronate, and raloxifene on renal functions, based on the Cockcroft and Gault method, in postmenopausal women [J]. Ren Fail, 2007, 29 (4): 471. [4] Aguiar BD, Bohn SU, Cabrera SMA, et al. Assessmentof renal toxicity and osteonecrosis of the jaws in patients receiving zoledronic acid for bone metastasis [J]. Ann Oncol, 2007, 18 (3): 556. [5] Woo S, Hellstein JW, Kalmar JR. Systematic Review: bisphosphonates and osteonecrosis of the jaws [J]. Ann Int Med, 2006, 144 (10): 7531. * * * * Calcif Tissue Int 1987; 41: 326–331. * * 这是一位患者在使用了6个月的唑来膦酸盐之后造成的上颌骨坏死 * 黄色表示新增 * * It is unclear as to why ibandronate has a safer renal profile than the alternative i.v. bisphosphonates, although this finding clearly argues against a class effect. The difference in nephrotoxic potential may relate to two pharmacokinetic differences. Compared to pamidronate and zoledronate, ibandronate is more highly protein bound (87% vs 54 and 56%), which may limit renal exposure to free drug.16 Second, the renal tissue half life of ibandronate is much shorter than zoledronate,16 p