Adalimumab: Another Medication Related to Osteonecrosis of the Jaws?

Abstract

Objective. The acronym MRONJ has been created in order to identify “Medication-Related Osteonecrosis of the Jaw,” observed after the use of Bisphosphonates, RANK ligand inhibitor, and antiangiogenic medications. Only a case of osteonecrosis of the jaw in a Chron's disease patient following a course of Bisphosphonate and Adalimumab therapy has been recently described, so that it has been supposed that also this medication could promote manifestation of osteonecrosis. Clinical Case. On August, 2014, a 63-year-old female with a history of idiopathic arthritis treated with medical treatment with Adalimumab from 2010 to 2013 presented referring pain in the right mandible. Results. This patient presented with nonexposed osteonecrosis of the jaw after placement, on September, 2010, of four titanium fixtures in the mandible. Conclusions. The authors suggest that the biologic therapy with an anti-TNF-α antibody might promote the manifestation of osteonecrosis and compromise oral healing capacity of the bone.

SIRT1/HERC4 Locus Associated With Bisphosphonate-Induced Osteonecrosis of the Jaw: An Exome-Wide Association Analysis

“…In the updated guidelines from the American Association of Oral and Maxillofacial Surgeons (AAOMS), the term “medication‐related osteonecrosis of the jaw (MRONJ)” was introduced in light of the large body of evidence linking ONJ to non‐BP drugs indicating that ONJ is no longer considered a class adverse effect of BPs. ONJ has been associated with other classes of drugs, including RANKL inhibitors, vascular endothelial growth factor (VEGF) inhibitors, as well as mammalian target of rapamycin (m‐TOR) inhibitors, and more recently, adalimumab (\an inhibitor for tumor necrosis factor α, TNF‐α) has also been found to be associated with ONJ …”

“…ONJ has been associated with other classes of drugs, including RANKL inhibitors, vascular endothelial growth factor (VEGF) inhibitors, as well as mammalian target of rapamycin (m-TOR) inhibitors, (5) and more recently, adalimumab (an inhibitor for tumor necrosis factor a, TNF-a) has also been found to be associated with ONJ. (6) Although more than a decade has passed since the first reported cases of ONJ, the pathophysiology of this disease remains elusive despite all ongoing efforts aimed at not only deciphering its pathogenesis but also identifying the patients at risk of developing ONJ when treated with relevant medications. The fact that ONJ develops in a minority of patients receiving the aforementioned drug classes suggests that genetics may contribute to or has a role in its pathogenesis.…”

A Case of Intra-Oral Bone Exposure of the Hard Palate: A Clinical Diagnostic Dilemma

“…ONJ may be related to adalimumab and/or infliximab therapy, 2 anti TNF-α antibody used to treat Crohn's disease and other autoimmune diseases. Few authors reported a relationship between infliximab and/or adalimumab therapy and appearance of ONJ [2][3][4]. In this particular case the area of exposed bone didn't appear after a surgical odontostomatological procedure, but the patient showed a severe generalized periodontitis, a well known ONJ risk factor.…”

Osteonecrosis and osteomyelitis of the jaw associated with tumour necrosis factor-alpha (TNF-α) inhibitors: a systematic review

“…No. of patients Ciantar 2007 29 Case report 1 Cassoni 2016 30 Case report 1 Tsuchiya 2016 31 Case report 1 Aghaloo 2017 32 Case study 1* Favia 2017 33 Case report 1 Cillo 2019 34 Case report 1 * 6 patients but only 1 fitted the criteria for this review.…”