Rituximab as a trigger factor of medication-related osteonecrosis of the jaw. A case report

Javelot, Marie-José; Sergheraert, Johan; Agbo-Godeau, Scarlette; Lévy-Weil, Florence; Laurence, Sandy; Goudot, P.; Khonsari, R.H.; Mauprivez, Cédric

doi:10.1016/j.jormas.2019.06.009

Cited by 15 publications

(12 citation statements)

References 15 publications

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“…Targeted drugs, including sunitinib, erlotinib, gefitinib, icotinib, and apatinib, act as tyrosine kinase inhibitors (TKIs) which work on the epidermal growth factor receptor (EGFR) or vascular endothelial growth factor (VEGF) receptor [ 25 , 26 ]. In addition, human monoclonal antibodies such as rituximab also have antiangiogenic effects [ 27 ]. In the present study, we demonstrated that targeted therapy was a risk factor for stage 3 MRONJ and gefitinib was the most used targeted drug among MRONJ patients.…”

Section: Discussionmentioning

confidence: 99%

Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study

Zhou

Shi

et al. 2020

BioMed Research International

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Objectives. Patients with stage 3 medication-related osteonecrosis of the jaw (MRONJ) suffer from severe complications. Chemotherapeutic agents and targeted drugs are considered to be associated with the development of MRONJ. However, little is known regarding the association of those agents with stage 3 MRONJ. The purpose of this study is to analyze the comprehensive medication history of patients with advanced-stage MRONJ (stage 2 and stage 3) and evaluate the possible risk factors for stage 3 MRONJ. Patients and Methods. Sixty patients with advanced-stage MRONJ were involved in this retrospective study. Patients with developmental maxillofacial anomalies, previous radiation in the head and neck areas, and jaw bone tumors were excluded from the study. All patients were divided into two groups by their MRONJ stage (stage 2 or stage 3). Demographic and clinical characteristics, comprehensive medication data (bisphosphonates, chemotherapeutic agents, targeted drugs, and immunosuppressive agents), and results of serological biomarkers were recorded and compared between two groups. Univariate and multivariate logistic regressions were performed by SPSS 25.0 for evaluating risk factors of stage 3 MRONJ. Results. Our results indicate that chemotherapy ( adjusted OR = 3.43 ; 95% CI: 1.03 to 11.38), targeted drugs ( adjusted OR = 3.69 ; 95% CI: 1.06 to 12.80), and maxillary lesions ( adjusted OR = 4.26 ; 95% CI: 1.19 to 15.23) increase the risk of stage 3 MRONJ. Conclusion. The outcome of this study justifies that chemotherapeutic agents and targeted drugs are probably risk factors for stage 3 MRONJ. In addition, the osteonecrosis in maxilla is more easily to develop into stage 3 MRONJ. Intense clinical observation is recommended in MRONJ patients with maxillary osteonecrosis and in those who concurrently administered bisphosphonates, chemotherapeutic agents, and/or targeted drugs. This trial is registered with ChiCTR2000032428.

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Section: Discussionmentioning

confidence: 99%

Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study

Zhou

Shi

et al. 2020

BioMed Research International

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“…Association between the use of biologic DMARDs, including Bellimumab 121 and Rituximab, and ON in SLE patients has not been established yet, although Rituximab, an anti‐CD20 antibody, has been suggested as a cause of medication‐related ON of the jaw. 122 The use of DMARDs may result in the use of lower doses of glucocorticoids in SLE patients, which may affect the incidence of ON in SLE patients. Overall, the current research is insufficient to understand the impact of DMARD's on ON in SLE patients and further research needs to be conducted to fully understand the correlation between DMARDs and ON.…”

Section: Risk Factors For the Development Of On In Patients With Slementioning

confidence: 99%

Glucocorticoid‐induced osteonecrosis in systemic lupus erythematosus patients

Kaneko

Chen

Kaufman

et al. 2021

Clinical & Translational Med

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Osteonecrosis (ON) is a complex and multifactorial complication of systemic lupus erythematosus (SLE). ON is a devastating condition that causes severe pain and compromises the quality of life. The prevalence of ON in SLE patients is variable, ranging from 1.7% to 52%. However, the pathophysiology and risk factors for ON in patients with SLE have not yet been fully determined. Several mechanisms for SLE patients’ propensity to develop ON have been proposed. Glucocorticoid is a widely used therapeutic option for SLE patients and high‐dose glucocorticoid therapy in SLE patients is strongly associated with the development of ON. Although the hips and knees are the most commonly affected areas, it may be present at multiple anatomical locations. Clinically, ON often remains undetected until patients feel discomfort and pain at specific sites at which point the process of bone death is already advanced. However, strategies for prevention and options for treatment are limited. Here, we review the epidemiology, risk factors, diagnosis, and treatment options for glucocorticoid‐induced ON, with a specific focus on patients with SLE.

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“…This class of drug is known to alter the defense capabilities of neutrophils inhibiting their viability and differentiation capability and impairing normal wound healing 20. The immunological implications were also reported during Rituximab administration, an anti-CD20 monoclonal antibody used for rheumatoid arthritis 21. The authors suggested that Rituximab as immunosuppressant might be direct cause or another accelerating factor towards MRONJ development.…”

Section: Discussionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaw: 14 Years’ Retrospective Study on Pathogenetic Trigger Events

Marino

Squillacioti

Giudice

et al. 2022

Journal of Craniofacial Surgery

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Although events such as tooth extraction and oral surgery were considered for a while the sole triggering factor for Medication-Related Osteonecrosis of the Jaw (MRONJ), it is still unclear if trigger events may be precipitating factors that accelerate the onset of the disease that would have possibly occurred anyway. Therefore, this research aimed to retrospectively analyze MRONJ cases diagnosed in our tertiary referral hospital during the last 14 years, focusing on the onset of the disease, potential trigger events, and countermeasures to update the knowledge on their From the

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Rituximab as a trigger factor of medication-related osteonecrosis of the jaw. A case report

Cited by 15 publications

References 15 publications

Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study

Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study

Glucocorticoid‐induced osteonecrosis in systemic lupus erythematosus patients

Medication-Related Osteonecrosis of the Jaw: 14 Years’ Retrospective Study on Pathogenetic Trigger Events

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