Pamidronate May Work As Calciphylaxis Therapy

Three patients treated with the bisphosphonate experienced resolution of necrotic ulcers.
Three patients treated with the bisphosphonate experienced resolution of necrotic ulcers.

Researchers reported at the National Kidney Foundation's 2014 Spring Clinical Meetings in Las Vegas that they have successfully used intravenous (IV) pamidronate to treat calciphylaxis in patients with end-stage renal disease (ESRD).

The condition is characterized by calcium-phosphorus deposition in small vessels leading to tissue necrosis. The prognosis is poor.

Narittaya Varothai, MD, and Erdel Sarac, MD, of Elizabeth Health Center in Youngstown, Ohio, described 3 cases in which treatment IV pamidronate—a bisphosphonate—led to clinical improvement. One case involved a 51-year-old white obese patient hospitalized with painful ulcers in the lower abdomen and both thighs. The patient was treated with daily dialysis for 10 days followed by 4-hour dialysis sessions thrice weekly and pamidronate 30 mg IV once daily for 5 days.

A second case involved a 56-year-old white obese patient hospitalized with painful ulcers in both legs. The patient was treated with daily dialysis for 10 days followed by 4-hour dialysis sessions thrice weekly and pamidronate 30 mg IV once daily for 4 days. The ulcers improved significantly.

The third case involved a 51-year-old white patient hospitalized with multiple necrotic ulcers on the left leg. Treatment included daily dialysis for 7 days followed by 4-hour dialysis sessions thrice weekly and pamidronate 30 mg IV once daily for 2 days. The patient's condition improved within 1 month.

The investigators explained that bisphosphonates suppress an inflammatory syndrome through inhibition of macrophage activity and the release of proinflammatory cytokines. “This cellular effect may play an important role in rapid healing of necrotic ulcer[s],” they noted.

At the NKF's Spring Clinical Meetings in 2011, researchers reported promising results using a 3-week regimen of sodium thiosulfate to treat calciphylaxis in 3 ESRD patients. The patients had pain erythematous patches that progressed to necrotic ulcers on their extremities. All responded to treatment.

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