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Forsteo ® (teriparatide)

This information is intended for UK registered healthcare professionals only as a scientific exchange in response to your search for information.For current prescribing information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk (England, Scotland, Wales) or www.emcmedicines.com/en-GB/northernireland/ (Northern Ireland).

Forsteo® (teriparatide): Use in Patients with Monoclonal Gammopathy of Undetermined Significance

Patients with MGUS are at risk for progression to multiple myeloma or related malignancies. Patients with skeletal malignancies or bone metastases should be excluded from treatment with Forsteo (contraindication).

Monoclonal Gammopathy of Undetermined Significance

Monoclonal gammopathy of undetermined significance (MGUS) has an approximately 1% per year risk for progression to multiple myeloma or related malignancies.1 

If a patient has MGUS with a likelihood of progression to multiple myeloma, the clinician may consider not prescribing teriparatide.

Risk factors for a patient with MGUS to progress to multiple myeloma or related malignancies include

  • younger age2

  • size of the M protein when diagnosed1

  • abnormal serum free light chain ration3

  • presence of IgM or IgA M protein1

  • more than 5% bone marrow plasma cells1

  • presence of Bence Jones proteinuria1

  • polyclonal immunoglobulin reduction1, and

  • elevated sedimentation rate.1

References

1. Kyle RA, Rajkumar SV. Monoclonal gammopathy of undetermined significance and smouldering multiple myeloma: emphasis on risk factors for progression. Br J Haematol. 2007;139(5):730-743. http://dx.doi.org/10.1111/j.1365-2141.2007.06873.x

2. Kyle RA, Therneau TM, Rajkumar SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006;354(13):1362-1369. http://dx.doi.org/10.1056/NEJMoa054494

3. Rajkumar SV, Kyle RA, Therneau TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood. 2005;106(3):812-817. http://dx.doi.org/10.1182/blood-2005-03-1038

Glossary

BMD = bone mineral density

IgA = immunoglobulin A

IgM = immunoglobulin M

M = monoclonal

MGUS = monoclonal gammopathy of undetermined significance

Date of Last Review: 03 March 2020

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