Denosumab in Patients With Fibrous Dysplasia Previously Treated With Bisphosphonates

Majoor, B.C.J.; Papapoulos, S.E.; Dijkstra, P.D.S.; Fiocco, M.; Hamdy, N.A.T.; Appelman-Dijkstra, N.M.

doi:doi:10.1210/jc.2018-02543

Context: Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a rare bone disorder commonly treated with bisphosphonates, but clinical and biochemical responses may be incomplete.Objective: To evaluate the efficacy and tolerability of the receptor activator of nuclear factor-kappa B ligand inhibitor denosumab in the treatment of patients with FD/MAS refractory to bisphosphonate therapy.Design: Case series.Setting: Academic center of expertise for rare bone diseases.Patients: Data were collected from 12 consecutive patients with FD/MAS with persistent pain and increased biochemical markers of bone turnover (BTMs) after long-term treatment with bisphosphonates (median, 8.8 years) and were treated with subcutaneous denosumab 60 mg at 3- or 6-month intervals with a follow-up for at least 12 months.Main outcome(s): Sustained reduction of BTMs and bone pain.Results: A 60 mg dose of denosumab once every 3 months, but not once every 6 months, induced a sustained reduction of BTMs. After a...Show moreContext: Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a rare bone disorder commonly treated with bisphosphonates, but clinical and biochemical responses may be incomplete.Objective: To evaluate the efficacy and tolerability of the receptor activator of nuclear factor-kappa B ligand inhibitor denosumab in the treatment of patients with FD/MAS refractory to bisphosphonate therapy.Design: Case series.Setting: Academic center of expertise for rare bone diseases.Patients: Data were collected from 12 consecutive patients with FD/MAS with persistent pain and increased biochemical markers of bone turnover (BTMs) after long-term treatment with bisphosphonates (median, 8.8 years) and were treated with subcutaneous denosumab 60 mg at 3- or 6-month intervals with a follow-up for at least 12 months.Main outcome(s): Sustained reduction of BTMs and bone pain.Results: A 60 mg dose of denosumab once every 3 months, but not once every 6 months, induced a sustained reduction of BTMs. After a median treatment period of 15.5 months (range, 12 to 19) serum alkaline phosphatase activity and propeptide of type 1 procollagen levels were respectively reduced from 212 +/- 39.4 IU/L to 79 +/- 6.0 IU/L (P = 0.004) and from 346.2 +/- 111.1 ng/mL to 55.7 +/- 16.6 ng/mL (P = 0.023) and normalized in 70% and 75% of patients, respectively. Although not quantitavely measured, 10 patients reported a reduction in bone pain of whom 6 reported complete elimination of pain. Treatment with denosumab was well tolerated.Conclusion: Our results indicate that 60 mg of denosumab every 3 months is a promising, welltolerated treatment of most patients with FD/MAS refractory to bisphosphonate therapy. These results together with those of previously published case reports provide the necessary background for the design of a larger, controlled study.Show less

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Denosumab in Patients With Fibrous Dysplasia Previously Treated With Bisphosphonates