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Severity of acute phase reaction in children receiving the first dose of zoledronic acid and the impact of the underlying condition: a cross-sectional study
  1. Sapna Nayak1,2,
  2. Lauren Rayner1,
  3. Zulf Mughal1,3,
  4. Georgia McKinney4,
  5. Avril Mason4,
  6. Sze Choong Wong4,
  7. Raja Padidela1,3,
  8. Amish Chinoy1,3
  1. 1Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
  2. 2Paediatrics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  3. 3Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  4. 4Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
  1. Correspondence to Dr Amish Chinoy, Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK; amish.chinoy{at}mft.nhs.uk

Abstract

Introduction Zoledronic acid (ZA), used for treatment of children with osteoporosis, can cause acute phase reaction (APR) following the first infusion. Many institutions have a policy to admit and monitor all children for their first ZA infusion.

Objective To determine if the APR with the first ZA dose warrants hospital-level care and evaluate if its severity correlates with the underlying condition.

Design Retrospective cross-sectional analysis.

Settings Two tertiary centres across the UK that run paediatric metabolic bone disease services.

Patients Children who received first ZA infusion as inpatients at these centres.

Interventions Nil.

Main outcome measures The Paediatric Early Warning Score (PEWS) and length of hospital stay to assess the severity of APR.

Results 107 patients were included. Peak PEWS≤3 was found in 85% of children. 83% required admission for <24 hours. The various patient populations (osteogenesis imperfecta (OI), immobility-induced osteoporosis, idiopathic juvenile osteoporosis, systemic inflammatory disorders and steroid-induced osteoporosis, Duchenne muscular dystrophy (DMD)) did not differ significantly in the mean peak PEWS and the length of hospital stay. However, when compared directly, the group with DMD and that with systemic inflammatory disorders and steroid-induced osteoporosis differed significantly in the mean peak PEWS (p=0.011) and the length of hospital stay (p=0.048), respectively, as compared with the OI group.

Conclusion Most patients had a mild APR not requiring overnight hospital admission, after their first ZA dose. However, certain groups seem to suffer more severe APR and may warrant consideration of inpatient monitoring with the first infusion.

  • Endocrinology
  • Paediatrics

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors SN devised the study, collected and analysed the data, and drafted and revised the manuscript. LR, GM, AM and SCW collected the data and revised the manuscript. ZM and RP devised the study and revised the manuscript. AC devised the study, collected and analysed the data and revised the manuscript, and acts as guarantor for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SCW received funding from Novartis in 2017 for a one-off consultancy meeting regarding zoledronate.

  • Provenance and peer review Not commissioned; externally peer reviewed.