Authors: Saima Qasim1, Uzma Saleem2, Bashir Ahmad1, Muhammad Tahir Aziz3, M. Imran Qadir2, Saeed Mahmood4, Khurram Shahzad1

Keywords:Sixty patients of multiple myeloma were randomized into two equal groups to receive Pamidronate and Zoledronic acid intravenously every month for a total of six months. The primary endpoint was to compare the therapeutic efficacy of both drugs by the resolution of hypercalcemia, prevention of skeletal related events and pathological fractures. The secondary endpoints were to assess patient compliance on the basis of quality of life score before and after treatment with Pamidronate and Zoledronic acid and to analyze the cost effectiveness of both drugs., Pamidronate was found to be more effective in the resolution of hypercalcemia as compared to Zoledronic acid, whereas Zoledronic acid reduced the overall proportion of skeletal related events (45.9%) in comparison with Pamidronate (54.1%). Overall Quality of life scores were not significantly influenced by either the response or the occurrence of adverse event but were statistically significant (P=0.000), with in the treatment groups. Patients on Zoledronic acid were more comfortable due to short administration time of l5minutes as compared to 2 hours of Pamidronate. The average cost of six months’ treatment with Zoledronic acid was significantly higher (PKR=90, 000 or USD 1,052) in comparison with Pamidronate (PKR=39, 000 USD 456. Zoledronic acid reduced the risk of developing skeletal complications including hypercalcemia and was significantly more effective in reducing the incidence of hypocalcemia. The incidence of renal impairment among patients treated with Zoledronic acid was significantly higher, but severity of nephrotoxicity was more with Pamidronate. The most common adverse effects were pain, vomiting and fatigue in both treatment groups. Comparatively, Pamidronate was more effective in resolution of hypercalcemia, while Zoledronic acid have better therapeutic effects in reduction of skeletal related events and pathological fractures.