Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?   

Considering the boxed warning to stop Evenity in a patient who has a stroke or MI while receiving it, yes, I would stop it. It is the prudent thing to do. However, I know of no evidence of harm with continuing it, and I might consider continuing it if the balance of benefits and risks were overwhelm...

The question is why did he have an intracranial bleed? Did he have hypertension? I tend to avoid R with cardiovascular disease including hypertension because of the black box warning. Also, this drug has not lived up to what we thought it would be with the phase 3 study showing a very elevated NNT.

While there is uncertainty about the true risk of MACE with romosozumab, the biggest risk factor for MACE appears to be a stroke or MI in the last 1 year. Thus, romosozumab may increase the risk of recurrent stroke. Patients with a stroke have a high risk of recurrence The risk of recurrence was 1.2...

I would agree with Dr. @E. Michael Lewiecki. The most prudent action would be to stop the medication with a CVA. However, if the patient has very low BMD of the hip and had a high risk of hip fracture, I would probably continue it if the patient agreed. It is important to remember that many patients...

I agree with Dr. @E. Michael Lewiecki's answer. There is data that would help give a meaningful answer but in light of the boxed warning I would hold off on further romosozumab treatment for any patient with a cardiovascular event while being treated.