Published online Mar 12, 2017. doi: 10.5499/wjr.v7.i1.1
Peer-review started: December 5, 2016
First decision: January 16, 2017
Revised: February 10, 2017
Accepted: March 3, 2017
Article in press: March 5, 2017
Published online: March 12, 2017
To assess the knowledge and attitude of Lebanese physicians regarding bisphosphonates (BPs)-related complications.
An observational cross-sectional study was conducted at a major tertiary teaching hospital in Beirut city, and its affiliated primary health care center. Data were collected through a new self-administered questionnaire distributed via a delegated secretary to physicians expected to regularly prescribe BPs (n = 215). It assessed participants’ knowledge, fear and experience regarding BPs-reported complications.
One hundred and fifty-seven physicians fulfilled the questionnaire (response rate: 73.0%): 77.7% and 75.2% considered that gastrointestinal intolerance and osteonecrosis of the jaw are linked to BPs, respectively. Conversely, the least recognised complications are ocular inflammation (7.6%) and severe musculoskeletal pain (37.6%). The association of BPs with oesophageal cancer, atrial fibrillation and hepatotoxicity was reported by 11.5%, 13.4% and 24.8% of respondents, respectively. The multivariate analysis showed a significant association between level of knowledge and physicians’ department affiliation (P-value = 0.043), their gender (P-value = 0.044), whether or not they prescribe a BP (P-value = 0.012), and the number of BP prescriptions delivered monthly (P-value = 0.012). Physicians are mainly concerned about osteonecrosis of the jaw and nephrotoxicity when prescribing a BP. Yet, the complications commonly met in their practice are gastrointestinal intolerance (44.6%) and acute phase reactions (26.7%).
This study revealed the presence of a deficient knowledge regarding BPs-related adverse events among our physicians. Professional training proposals are needed to increase their knowledge and improve their practices. Pharmaceutical industries should reconsider the instructions they provide to physicians regarding the complications of medications they promote. Moreover, they must actively collaborate with education providers and institutions in educational interventions.
Core tip: Bisphosphonates (BPs) have been proven to be effective, tolerated and relatively safe to a large number of patients. However, they were associated with reports of multiple adverse events. Given the widespread use of these medications, detailed knowledge on occurrence of even rare side effects is imperative. In this study, we assess the knowledge and approach of our physicians regarding BPs-related complications. Eventually, this evaluation will facilitate the elaboration of appropriate training programs to increase their awareness and improve their practice. It will incite pharmaceutical companies to reconsider the instructions they provide to physicians about the complications of treatments they promote.