Severe hypocalcaemia post-denosumab
Hipocalcemia severa posdenosumab
Read
7767
Timeswas read the article
2416
Total PDF
5351
Total HTML
Share statistics
array:21 [ "pii" => "X2013251413052666" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2013.Apr.11922" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2013;33:614-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4485 "formatos" => array:3 [ "EPUB" => 339 "HTML" => 3437 "PDF" => 709 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699513052669" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2013.Apr.11922" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2013;33:614-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7543 "formatos" => array:3 [ "EPUB" => 279 "HTML" => 6573 "PDF" => 691 ] ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "Hipocalcemia severa posdenosumab" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "614" "paginaFinal" => "615" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Severe hypocalcaemia post-denosumab" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabel M. Martín-Baez, Raquel Blanco-García, Mario Alonso-Suárez, Cynthia Cossio-Aranibar, Laura V. Beato-Coo, Francisco Fernández-Fleming" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Isabel M." "apellidos" => "Martín-Baez" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Blanco-García" ] 2 => array:2 [ "nombre" => "Mario" "apellidos" => "Alonso-Suárez" ] 3 => array:2 [ "nombre" => "Cynthia" "apellidos" => "Cossio-Aranibar" ] 4 => array:2 [ "nombre" => "Laura V." "apellidos" => "Beato-Coo" ] 5 => array:2 [ "nombre" => "Francisco" "apellidos" => "Fernández-Fleming" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251413052666" "doi" => "10.3265/Nefrologia.pre2013.Apr.11922" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052666?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052669?idApp=UINPBA000064" "url" => "/02116995/0000003300000004/v0_201502091404/X0211699513052669/v0_201502091405/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251413052658" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2013.May.11930" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2013;33:615-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5078 "formatos" => array:3 [ "EPUB" => 327 "HTML" => 4122 "PDF" => 629 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Passenger lymphocyte syndrome: an uncommon form of anaemia in renal transplantation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "615" "paginaFinal" => "616" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome del linfocito pasajero: una rara forma de anemia en el trasplante renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Verónica Pascual Pérez, Verónica Pascual-Pérez, Nerea Gómez Larrambe, Nerea Gómez-Larrambe, Rocío Collantes Mateos, Rocío Collantes-Mateos, Teresa Visus Fernández de Manzanos, Teresa Visus-Fernández de Manzanos, José Manuel Urbizu Gallardo, José M. Urbizu-Gallardo, Auxiliadora Mazuecos Blanca, Auxiliadora Mazuecos-Blanca" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Verónica" "apellidos" => "Pascual Pérez" ] 1 => array:2 [ "nombre" => "Verónica" "apellidos" => "Pascual-Pérez" ] 2 => array:2 [ "nombre" => "Nerea" "apellidos" => "Gómez Larrambe" ] 3 => array:2 [ "nombre" => "Nerea" "apellidos" => "Gómez-Larrambe" ] 4 => array:2 [ "nombre" => "Rocío" "apellidos" => "Collantes Mateos" ] 5 => array:2 [ "nombre" => "Rocío" "apellidos" => "Collantes-Mateos" ] 6 => array:2 [ "nombre" => "Teresa" "apellidos" => "Visus Fernández de Manzanos" ] 7 => array:2 [ "nombre" => "Teresa" "apellidos" => "Visus-Fernández de Manzanos" ] 8 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Urbizu Gallardo" ] 9 => array:2 [ "nombre" => "José M." "apellidos" => "Urbizu-Gallardo" ] 10 => array:2 [ "nombre" => "Auxiliadora" "apellidos" => "Mazuecos Blanca" ] 11 => array:2 [ "nombre" => "Auxiliadora" "apellidos" => "Mazuecos-Blanca" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699513052650" "doi" => "10.3265/Nefrologia.pre2013.May.11930" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052650?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052658?idApp=UINPBA000064" "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052658/v0_201502091630/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251413052674" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2013.Apr.11914" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2013;33:613-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3576 "formatos" => array:3 [ "EPUB" => 298 "HTML" => 2689 "PDF" => 589 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Pregnancy in patient with cirrhosis and cryoglobulinemic vasculitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "613" "paginaFinal" => "614" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gioacchino Li Cavoli, Carlo Giammarresi, Calogera Tortorici, Luisa Bono, Angelo Ferrantelli, Ugo Rotolo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Gioacchino" "apellidos" => "Li Cavoli" ] 1 => array:2 [ "nombre" => "Carlo" "apellidos" => "Giammarresi" ] 2 => array:2 [ "nombre" => "Calogera" "apellidos" => "Tortorici" ] 3 => array:2 [ "nombre" => "Luisa" "apellidos" => "Bono" ] 4 => array:2 [ "nombre" => "Angelo" "apellidos" => "Ferrantelli" ] 5 => array:2 [ "nombre" => "Ugo" "apellidos" => "Rotolo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X0211699513052677" "doi" => "10.3265/Nefrologia.pre2013.Apr.11914" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052677?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052674?idApp=UINPBA000064" "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052674/v0_201502091630/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Severe hypocalcaemia post-denosumab" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "614" "paginaFinal" => "615" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Isabel M. Martín-Baez, Raquel Blanco-García, Mario Alonso-Suárez, Cynthia Cossio-Aranibar, Laura V. Beato-Coo, Francisco Fernández-Fleming" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Isabel M." "apellidos" => "Martín-Baez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "Raquel" "apellidos" => "Blanco-García" "email" => array:1 [ 0 => "raquelblancog@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Mario" "apellidos" => "Alonso-Suárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Cynthia" "apellidos" => "Cossio-Aranibar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Laura V." "apellidos" => "Beato-Coo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Francisco" "apellidos" => "Fernández-Fleming" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Complexo Hospitalario Universitario de Vigo, Pontevedra, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipocalcemia severa posdenosumab" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor:</span></p><p class="elsevierStylePara">Denosumab is a human IgG2 monoclonal antibody that binds to RANKL (receptor activator of nuclear factor KB ligand gene), thus causing a reduction in osteoclast activity. It has been approved since 2010 for use in osteoporosis and does not require adjustment in accordance with renal function, although several studies indicate an increase of hypocalcaemia in patients with renal failure (RF). It is administered subcutaneously biannually.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">We report the case of a 46-year-old woman with high blood pressure, dyslipidaemia, stage 5 chronic kidney disease (CKD), focal segmental glomerulonephritis and severe seronegative rheumatoid arthritis resistant to different drugs. Due to the presence of pathologic fractures to the pelvis, the Department of Rheumatology decided to start treatment with 60mg denosumab. She received treatment with 2.4g/12 hours sevelamer, 0.50mg Rocaltrol<span class="elsevierStyleSup">®</span>: 5 tablets/week, 1 tablet/8 hours Mastical<span class="elsevierStyleSup">®</span>, 266μg/15 days calcifediol, antihypertensive drugs and painkillers. The analytical data were: urea 205mg/dl, creatinine 5.95mg/dl, calcium 8.8mg/dl, albumin 3.8g/dl, intact parathyroid hormone 581pg/ml, 25-OH vitamin D 9.2ng/ml, alkaline phosphatase 221U/l.</p><p class="elsevierStylePara">One week after the drug was administered, we detected hypocalcaemia (6.7mg/dl corrected calcium) in a routine clinic blood test. The patient was asymptomatic and because of significant history of poor adherence to treatment, she was urged to adhere to treatment as prescribed.</p><p class="elsevierStylePara">Two weeks later, the patient came to the Emergency department with general weakness, dizziness, tremors and nausea. Corrected calcium of 5.2mg/dl was detected. Physical examination revealed no signs of hypocalcaemia (Trousseau or Chvostek) or peribuccal paresthesia.</p><p class="elsevierStylePara">It was decided to admit the patient for intravenous treatment, which yielded good clinical and laboratory results.</p><p class="elsevierStylePara">Bisphosphonates are commonly used to reduce bone loss but they are mainly eliminated through the kidney, and as such, their use is not recommended in patients with severe RF.<span class="elsevierStyleSup">2</span> Denosumab significantly reduces the risk of fractures<span class="elsevierStyleSup">3</span> and it has been shown to increase bone mineral density and reduce resorption markers. Furthermore, preclinical studies have revealed that, unlike bisphosphonate, it is not nephrotoxic at levels of 100μmol/l<span class="elsevierStyleSup">4</span> and is independent of the degree of RF, since its pharmacokinetic and pharmacodynamic profile does not vary significantly according to the degree of renal function.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">It has been hypothesised that patients with CKD and bone disease due to hyperparathyroidism may be at greater risk of hypocalcaemia with denosumab, since their serum calcium levels will depend to a greater extent on bone resorption mediated by the parathyroid hormone. As such, inhibition of osteoclast activity following administration of the first dose of denosumab could lead to a syndrome similar to hungry bone, with the rapid decrease in serum calcium levels due to its uptake by bone.<span class="elsevierStyleSup">5</span> At this time, calcium and vitamin D supplements are required, until the formation of osteoclasts leads to proper mineralisation.</p><p class="elsevierStylePara">In a study<span class="elsevierStyleSup">6</span> conducted on 46 patients with varying degrees of RF, pain in limbs and hypocalcaemia were observed as the most common adverse effects. The latter appeared in 15% of participants, with only two patients requiring hospitalisation for intravenous treatment and in only one, hypocalcaemia was symptomatic.</p><p class="elsevierStylePara">The use of denosumab in patients with CRF is convenient, as it requires no dose adjustment and it is not nephrotoxic; as such, its use is expected to increase. In this group of patients, we should administer appropriate calcium and vitamin D supplements before beginning treatment with denosumab, in addition to monitoring these parameters in the laboratory after treatment begins, since a non-negligible number of patients will develop hypocalcaemia, which will be asymptomatic in the majority of cases.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p>" "pdfFichero" => "P1-E557-S4311-A11922-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Prolia (denosumab) product monograph. Mississauga. ON: Amgen Canada Inc; 2011." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Perazella MA, Markowitz GS. Biphosphonate nephrotoxicity. Kidney Int 2008;74:1385-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18685574" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0140673609603251" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cummings SR, San Martín J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361:756-65. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19671655" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Padagas J, Colloton M, Shalhoub V, Kostenuik P, Morony S, Munyakazi L, et al. The receptor activator of nuclear factor-kappaB ligand inhibitor osteoprotegerin is a bone-protective agent in a rat model of chronic renal insufficiency and hyperparathyroidism. Calcif Tissue Int 2006;78:35-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16362459" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Westenfeld R, Ketteler M, Brandenburg VM. Anti-RANKL therapy-implications for the bone-vascular-axis in CKD? Denosumab in post-menopausal women with various low bone mineral density. Nephrol Dial Transplant 2006;21(8):2075-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16702197" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Block GA, Bone HG, Fang L, Lee E, Padhi D. A single-dose study of denosumab in patients with various degrees of renal impairment. J Bone Miner Res 2012;27:1471-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22461041" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052666/v0_201502091630/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000004/v0_201502091629/X2013251413052666/v0_201502091630/en/P1-E557-S4311-A11922-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052666?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 6 | 13 |
| 2024 October | 45 | 42 | 87 |
| 2024 September | 53 | 32 | 85 |
| 2024 August | 59 | 47 | 106 |
| 2024 July | 42 | 31 | 73 |
| 2024 June | 41 | 43 | 84 |
| 2024 May | 46 | 33 | 79 |
| 2024 April | 58 | 39 | 97 |
| 2024 March | 30 | 27 | 57 |
| 2024 February | 32 | 38 | 70 |
| 2024 January | 31 | 24 | 55 |
| 2023 December | 19 | 26 | 45 |
| 2023 November | 37 | 35 | 72 |
| 2023 October | 22 | 37 | 59 |
| 2023 September | 32 | 29 | 61 |
| 2023 August | 27 | 25 | 52 |
| 2023 July | 35 | 29 | 64 |
| 2023 June | 31 | 24 | 55 |
| 2023 May | 43 | 41 | 84 |
| 2023 April | 25 | 21 | 46 |
| 2023 March | 35 | 28 | 63 |
| 2023 February | 33 | 28 | 61 |
| 2023 January | 31 | 32 | 63 |
| 2022 December | 38 | 41 | 79 |
| 2022 November | 40 | 29 | 69 |
| 2022 October | 38 | 52 | 90 |
| 2022 September | 47 | 53 | 100 |
| 2022 August | 32 | 41 | 73 |
| 2022 July | 32 | 40 | 72 |
| 2022 June | 27 | 30 | 57 |
| 2022 May | 33 | 35 | 68 |
| 2022 April | 31 | 38 | 69 |
| 2022 March | 33 | 27 | 60 |
| 2022 February | 25 | 37 | 62 |
| 2022 January | 28 | 27 | 55 |
| 2021 December | 36 | 35 | 71 |
| 2021 November | 35 | 41 | 76 |
| 2021 October | 45 | 36 | 81 |
| 2021 September | 32 | 30 | 62 |
| 2021 August | 86 | 43 | 129 |
| 2021 July | 30 | 34 | 64 |
| 2021 June | 30 | 14 | 44 |
| 2021 May | 32 | 41 | 73 |
| 2021 April | 70 | 39 | 109 |
| 2021 March | 36 | 23 | 59 |
| 2021 February | 31 | 26 | 57 |
| 2021 January | 18 | 16 | 34 |
| 2020 December | 20 | 15 | 35 |
| 2020 November | 20 | 17 | 37 |
| 2020 October | 24 | 13 | 37 |
| 2020 September | 20 | 11 | 31 |
| 2020 August | 25 | 13 | 38 |
| 2020 July | 11 | 10 | 21 |
| 2020 June | 22 | 17 | 39 |
| 2020 May | 25 | 17 | 42 |
| 2020 April | 26 | 21 | 47 |
| 2020 March | 13 | 15 | 28 |
| 2020 February | 29 | 28 | 57 |
| 2020 January | 25 | 30 | 55 |
| 2019 December | 16 | 21 | 37 |
| 2019 November | 15 | 20 | 35 |
| 2019 October | 20 | 13 | 33 |
| 2019 September | 34 | 13 | 47 |
| 2019 August | 12 | 11 | 23 |
| 2019 July | 18 | 24 | 42 |
| 2019 June | 18 | 13 | 31 |
| 2019 May | 31 | 19 | 50 |
| 2019 April | 53 | 38 | 91 |
| 2019 March | 37 | 24 | 61 |
| 2019 February | 28 | 30 | 58 |
| 2019 January | 25 | 30 | 55 |
| 2018 December | 51 | 42 | 93 |
| 2018 November | 71 | 15 | 86 |
| 2018 October | 94 | 9 | 103 |
| 2018 September | 50 | 20 | 70 |
| 2018 August | 34 | 16 | 50 |
| 2018 July | 38 | 14 | 52 |
| 2018 June | 47 | 12 | 59 |
| 2018 May | 40 | 7 | 47 |
| 2018 April | 51 | 11 | 62 |
| 2018 March | 53 | 7 | 60 |
| 2018 February | 48 | 8 | 56 |
| 2018 January | 54 | 11 | 65 |
| 2017 December | 38 | 6 | 44 |
| 2017 November | 51 | 9 | 60 |
| 2017 October | 36 | 7 | 43 |
| 2017 September | 36 | 16 | 52 |
| 2017 August | 43 | 14 | 57 |
| 2017 July | 42 | 12 | 54 |
| 2017 June | 40 | 14 | 54 |
| 2017 May | 39 | 15 | 54 |
| 2017 April | 32 | 17 | 49 |
| 2017 March | 20 | 20 | 40 |
| 2017 February | 25 | 15 | 40 |
| 2017 January | 32 | 18 | 50 |
| 2016 December | 63 | 12 | 75 |
| 2016 November | 61 | 15 | 76 |
| 2016 October | 75 | 15 | 90 |
| 2016 September | 107 | 6 | 113 |
| 2016 August | 165 | 11 | 176 |
| 2016 July | 196 | 14 | 210 |
| 2016 June | 131 | 0 | 131 |
| 2016 May | 160 | 0 | 160 |
| 2016 April | 116 | 0 | 116 |
| 2016 March | 94 | 0 | 94 |
| 2016 February | 112 | 0 | 112 |
| 2016 January | 102 | 0 | 102 |
| 2015 December | 118 | 0 | 118 |
| 2015 November | 94 | 0 | 94 |
| 2015 October | 77 | 0 | 77 |
| 2015 September | 82 | 0 | 82 |
| 2015 August | 72 | 0 | 72 |
| 2015 July | 75 | 0 | 75 |
| 2015 June | 46 | 0 | 46 |
| 2015 May | 52 | 0 | 52 |
| 2015 April | 22 | 0 | 22 |
Show all
