Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis

Srivastava, Akanksha; Nogueras‐González, Graciela M.; Geng, Yimin; Won, Alexander M.; Cabanillas, Maria E.; Naing, Aung; Myers, Jeffrey N.; Li, Yisheng; Chambers, Mark S.

doi:10.1007/s00520-020-05882-3

Cited by 35 publications

(40 citation statements)

References 47 publications

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“…Severe side effects must be considered and prevention of osteonecrosis of the jaw should be performed based on the ASORS (Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin) evaluation [22]. Planned sequential therapy with multiple bone-targeted agents should be approached with caution based on higher osteonecrosis of the jaw rates (LoE 2b/B/AGO+/–) [23]. In case of spinal cord compression, treatment should begin immediately (LoE 1c/D/AGO++) and steroids should be started at first symptoms (LoE 2a/C/AGO+) [24].…”

Section: Bone Metastasismentioning

confidence: 99%

AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2021

et al. 2021

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Section: Bone Metastasismentioning

confidence: 99%

AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2021

et al. 2021

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“…Five years later, new oncology drugs and other types of antiresorptive therapies were progressively linked to this avascular necrosis from case reports to adverse events of long-term follow-up of randomized trials [ 10 , 11 ]. In addition, anti-angiogenic agents such as monoclonal antibodies against VEGF (i.e., Bevacizumab, Aflibercept), tyrosine kinase inhibitors (i.e., Sunitinib, Sorafenib, Imatinib, Axitinib, and Cabozantinib), and mTOR inhibitors (i.e., Temsirolimus and Everolimus) [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review

Lorenzo-Pouso

Bagán

et al. 2021

JCM

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Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.

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“…We previously published another systematic review using the same methodology to estimate the prevalence of MRONJ with sequential AR therapy. [22] The study revealed a higher prevalence of MRONJ when two or more AR drugs were administered sequentially compared with a single AR drug. Within this study, [22] the effect of addition of AA drugs was not evaluated.…”

Section: Study Selection and Data Extractionmentioning

confidence: 87%

Medication-Related Osteonecrosis of the Jaw in Patients Treated Concurrently with Antiresorptive and Antiangiogenic Agents: Systematic Review and Meta-Analysis

Srivastava

González

Geng

et al. 2021

Journal of Immunotherapy and Precision Oncology

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Introduction Medication-related osteonecrosis of the jaws (MRONJ) is a known adverse event related to the use of antiresorptive (AR) drugs. More recently, an association between antiangiogenic (AA) drugs and MRONJ has been suggested. This review aimed to investigate the overall prevalence and relative risk of MRONJ in patients treated concurrently with AA and AR agents in comparison with a single AA or AR drug. Methods A review protocol was registered with PROSPERO (ID: CRD42020214244). A systematic literature search, study selection, quality assessment, and data extraction were carried out following PRISMA guidelines. Random-effects meta-analysis models were used to summarize relative estimates for the outcomes, namely prevalence and relative risk of MRONJ. Exposure variable included type of drug, specifically AA and AR agents administered either concurrently or individually. Results Eleven studies were included in the final qualitative and quantitative syntheses. The overall pooled weighted prevalence of MRONJ with concurrent AA-AR drugs was 6% (95% CI: 3–8%), compared with 0% (95% CI: 0–0%) for AA only and 5% (95% CI: 0–10%) for AR only. However, high heterogeneity was noted among included studies. Retrospective cohort studies showed a higher pooled prevalence of 13% (95% CI: 10–17%) for concurrent AA-AR therapy. The pooled risk ratio for MRONJ revealed a risk with concurrent AA-AR drugs 2.57 times as high as with AR only (95% CI: 0.84–7.87); however, this difference was not statistically significant. Concurrent AA-AR drugs had a risk for MRONJ 23.74 times as high as with AA only (95% CI: 3.71–151.92). Conclusions High-quality, representative studies are needed for accurate estimation of relative risk of MRONJ with concurrent AA and AR therapy.

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Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis

Cited by 35 publications

References 47 publications

AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2021

AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2021

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review

Medication-Related Osteonecrosis of the Jaw in Patients Treated Concurrently with Antiresorptive and Antiangiogenic Agents: Systematic Review and Meta-Analysis

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