Zhu Sheng, Yang Yu-Hui, Gao Rong-Wei, Li Ran, Zou Yu-Zhen, Feng Lei, Zhang Bo
Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Drug Des Devel Ther. 2017 Dec 27;12:41-45. doi: 10.2147/DDDT.S140988. eCollection 2018.
To investigate the predictors of hypophosphatemic osteomalacia induced by adefovir dipivoxil (ADV) and to monitor for early detection.
Hospitalized patients who were diagnosed with ADV-related hypo-phosphatemic osteomalacia were recruited and retrospectively analyzed in our hospital from January 2012 to December 2016. A telephone interview was conducted at 1, 3, 6, 9, 12, and 24 months after cessation of ADV.
In the 8 patients enrolled in the study, the hypophosphatemic osteomalacia symptoms developed at an average of 5.14 (4-7) years since ADV treatment (10 mg/d). The average alkaline phosphatase (ALP) level was 279.50 (137-548) U/L, which was significantly higher than the normal level (45-125 U/L). The serum phosphorus level was an average of 0.59 (0.43-0.69) mmol/L, which was lower than the normal range (2.06-2.60 mmol/L). Serum calcium levels of the enrolled patients remained within normal limits. Reduced estimated glomerular filtration rate (eGFR <29 mL/min/1.73 m) was seen in 4 cases. The clinical manifestations were mainly progressive systemic bone and joint pain, frequent fractures, trouble in walking, height reduction (4-6 cm), and so on. After cessation of ADV, symptoms like bone pain resolved gradually. Serum phosphorus level restored to normal in 4.5 months after the withdrawal of ADV. However, in 4 patients, renal function failed to return to normal in 24 months.
More attention should be paid to the duration of ADV treatment. The level of serum phosphorus and ALP, as well as renal function, should be monitored for early detection of potential adverse drug reactions.
探讨阿德福韦酯（ADV）所致低磷性骨软化症的预测因素并进行早期监测。
选取2012年1月至2016年12月在我院住院诊断为ADV相关低磷性骨软化症的患者进行回顾性分析。在停用ADV后的1、3、6、9、12和24个月进行电话随访。
纳入研究的8例患者中，低磷性骨软化症症状在开始ADV治疗（10mg/d）后平均5.14（4 - 7）年出现。碱性磷酸酶（ALP）平均水平为279.50（137 - 548）U/L，显著高于正常水平（45 - 125 U/L）。血清磷平均水平为0.59（0.43 - 0.69）mmol/L，低于正常范围（2.06 - 2.60 mmol/L）。纳入患者的血清钙水平保持在正常范围内。4例患者估算肾小球滤过率降低（eGFR <29 mL/min/1.73 m²）。临床表现主要为进行性全身骨与关节疼痛、频繁骨折行走困难、身高降低（4 - 6 cm）等。停用ADV后，骨痛等症状逐渐缓解。停用ADV后4.5个月血清磷水平恢复正常。然而，4例患者在24个月时肾功能未能恢复正常。
应更多关注ADV治疗时长。应监测血清磷、ALP水平以及肾功能，以便早期发现潜在的药物不良反应。
