Professor, Private Practitioner, Ludwig-Maximilians University Munich, Department of Oral and Maxillofacial Surgery Medizin & Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
Resident, Medizin & Aesthetik, Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
J Oral Maxillofac Surg. 2021 Mar;79(3):611-621. doi: 10.1016/j.joms.2020.10.005. Epub 2020 Oct 13.
Few data exist focusing on differences in the time to disease onset and the success rates in patients suffering from medication-related osteonecrosis of the jaw (MRONJ) dependent on their different antiresorptive treatment. The purpose of this study was to analyze and compare these variables for patients treated with bisphosphonate (BP) or denosumab (DNO) and for patients who switched the antiresorptive drug (BP/DNO).
A retrospective single-center cohort study with patients suffering from MRONJ was conducted. The predictor variable was the antiresorptive treatment, the outcome variables were 1) time to onset of MRONJ (time of antiresorptive treatment to MRONJ diagnosis) and 2) treatment success (mucosal integrity 12 months postoperatively). The other variables include data on demographic, underlying disease, MRONJ stage, and trigger events. Cox and logistic regression, Phi-coefficient, Cramer's V, and Kruskal-Wallis tests were applied.
One hundred thirty-two patients were included and divided into 3 groups: group I (BP) n = 45 patients, n = 59 lesions; group II (BP/DNO) n = 42 patients, n = 71 lesions; and group III (DNO) n = 45 patients, n = 62 MRONJ lesions. Treatment success and time to onset differed significantly between the groups: success rates in group I BP (84.7%) were significantly lower (P = .04) than in group II BP/DNO (91.5%, P = .12) and group III DNO (90.3%, P = .35). The onset was significantly earlier in group III DNO (median 2.0 years, Q: 1.49, Q: 2.98; confidence interval 95%: 1.93 to 2.83) than in group II BP/DNO (median 4.07 years, Q: 1.64, Q: 6.70; confidence interval 95%: 3.55 to 5.68) and group I BP (median 3.86 years, Q: 1.69, Q: 6.46; confidence interval 95%: 3.43 to 5.87).
The different antiresorptive drugs show distinctive characteristics of time to onset and treatment success with the lowest success rates in the BP group and the earliest onset in the DNO group. The switch of the antiresorptive therapy (BP to DNO) did not influence the outcome variables negatively.
针对药物相关性颌骨坏死（MRONJ）患者，由于不同的抗吸收药物治疗，发病时间和成功率存在差异，目前针对这一差异的相关数据较少。本研究旨在分析和比较接受双膦酸盐（BP）或地舒单抗（DNO）治疗的患者以及转换抗吸收药物（BP/DNO）的患者的这些变量。
进行了一项回顾性单中心队列研究，纳入了患有 MRONJ 的患者。预测变量为抗吸收治疗，结局变量为 1）MRONJ 发病时间（抗吸收治疗至 MRONJ 诊断的时间）和 2）治疗成功率（术后 12 个月的粘膜完整性）。其他变量包括人口统计学、基础疾病、MRONJ 分期和触发事件的数据。应用了 Cox 和逻辑回归、Phi 系数、Cramer's V 和 Kruskal-Wallis 检验。
共纳入 132 例患者，分为 3 组：I 组（BP）n=45 例，n=59 个病变；II 组（BP/DNO）n=42 例，n=71 个病变；III 组（DNO）n=45 例，n=62 个 MRONJ 病变。各组间治疗成功率和发病时间差异有统计学意义：I 组 BP（84.7%）的成功率明显低于 II 组 BP/DNO（91.5%，P=.12）和 III 组 DNO（90.3%，P=.35）。III 组 DNO 的发病时间明显更早（中位数 2.0 年，Q：1.49，Q：2.98；95%置信区间：1.93 至 2.83），明显早于 II 组 BP/DNO（中位数 4.07 年，Q：1.64，Q：6.70；95%置信区间：3.55 至 5.68）和 I 组 BP（中位数 3.86 年，Q：1.69，Q：6.46；95%置信区间：3.43 至 5.87）。
不同的抗吸收药物在发病时间和治疗成功率方面表现出不同的特征，BP 组的成功率最低，DNO 组的发病时间最早。抗吸收治疗的转换（BP 转为 DNO）并未对结局变量产生负面影响。
