(173) Teriparatide and Potential Risk of Multiple Myeloma

Publication Number: 504

Background: Teriparatide, a recombinant human parathyroid hormone, is approved by the Saudi Food and Drug Authority (SFDA) in 2018 for the treatment of osteoporosis in men and postmenopausal women at increased risk of fracture, and treatment of men and women with osteoporosis associated with sustained systemic glucocorticoid therapy at high risk for fracture.

Objectives: The aim of this research is to evaluate the potential risk of multiple myeloma (MM) with teriparatide use as a part of Proactive Drug Safety Monitoring Program initiated by the SFDA.

Methods: We conducted a systematic search in PubMed, Google Scholar and Adis Insight database to retrieve English articles from inception to March 22, 2021. The Search terms included “Teriparatide” OR “FORSTEO” AND “Multiple myeloma” OR “Plasma cell myeloma” OR “Myeloma”. Moreover, we searched in the World Health Organization (WHO) database (VigiBase) to retrieve reported cases until Jan 2022 via signal detection tool (Vigilyze) using the terms “Multiple myeloma” (Reaction Preferred Term (PT) (MedDRA)” and “Teriparatide "(substance (WHO Drug)).

Results: We included three published case reports for osteoporosis patients, who developed MM with the use of teriparatide treatment. In the first case, no examination performed for Monoclonal gammopathy of undetermined significance (MGUS) or MM pre-existed, before starting teriparatide. In the second case, the patient known to have MGUS before starting teriparatide, and then MM developed. In the third case, pre-investigations did not show monoclonal gammopathy in serum but raised β-2 globulins in urine before starting teriparatide.
Globally, there are 203 cases reported MM with the use of teriparatide retrieved from the WHO database. The WHO causality assessment was performed for 14 cases with a completeness score ≥0.9. Based on the WHO–UMC causality assessment, there were eight cases assessed as possible with reasonable temporality (time of onset is 3 months to 4 years). Two cases were assessed as unlikely, as the time to onset is less than one month. Four cases were considered un-assessable due to insufficient information.

Conclusions: Our review shows that teriparatide may increase the risk of developing MM in patients with MGUS. If a patient has MGUS with a likelihood of progression to multiple myeloma, the physician should consider not prescribing teriparatide unless the potential benefits of the medication outweigh any potential risks.