Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Int J Rheum Dis. 2021 Jan;24(1):63-68. doi: 10.1111/1756-185X.14018. Epub 2020 Nov 5.
Bisphosphonates may cause autoimmune reactions via a cytokine-mediated acute phase response. A case of giant cell arteritis (GCA) after zoledronate injection was recently reported. We aimed to evaluate this association by reviewing the incidence of GCA after bisphosphonate administration.
This was a retrospective study using the medical claims data of elderly patients in the 20% Medicare random sample from 2008-2014 who had received zoledronate or ibandronate. Patients who had a diagnosis claim of GCA within the past year before receiving either bisphosphonate were excluded. The development of GCA was assessed in 2 ways: GCA diagnosis claim within 28 days of bisphosphonate injection and another claim within 90 days of initial claim; and temporal artery biopsy claim within 28 days of bisphosphonate injection and GCA diagnosis claim within 90 days of biopsy. Due to the Centers for Medicare & Medicaid Services reporting requirements we excluded numbers less than 11 from analysis.
The incidence of GCA was 0.010% and 0.013% after zoledronate and ibandronate injection respectively. In the zoledronate group incidence was highest in patients aged 75-85 years (0.011%), in Whites (0.011%), in the northeast census region (0.013%) and higher in females (0.011% vs 0.009%). All GCA cases noted in the ibandronate group involved White females. We are unable to report incidences by age and region due to the paucity of data.
The incidence of GCA after bisphosphonate injection was not increased compared to the generally reported incidence in the USA.
双膦酸盐可能通过细胞因子介导的急性期反应引起自身免疫反应。最近报道了一例唑来膦酸注射后巨细胞动脉炎（GCA）的病例。我们旨在通过回顾双膦酸盐给药后 GCA 的发生率来评估这种关联。
这是一项回顾性研究，使用了 2008-2014 年接受唑来膦酸或伊班膦酸盐治疗的 20%医疗保险随机样本中老年人的医疗索赔数据。在接受双膦酸盐治疗前的过去 1 年内有 GCA 诊断的患者被排除在外。通过两种方式评估 GCA 的发生：双膦酸盐注射后 28 天内的 GCA 诊断和初始诊断后 90 天内的另一次诊断；以及双膦酸盐注射后 28 天内的颞动脉活检和 90 天内的 GCA 诊断。由于医疗保险和医疗补助服务中心的报告要求，我们排除了少于 11 个的数字进行分析。
唑来膦酸和伊班膦酸盐注射后 GCA 的发生率分别为 0.010%和 0.013%。在唑来膦酸组中，75-85 岁患者（0.011%）、白人（0.011%）、东北部普查区（0.013%）和女性患者（0.011%比 0.009%）的发生率最高。伊班膦酸盐组中所有 GCA 病例均涉及白人女性。由于数据匮乏，我们无法按年龄和地区报告发生率。
与美国普遍报告的发生率相比，双膦酸盐注射后 GCA 的发生率没有增加。
