Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge, Suite 5350, Houston, TX, 77054, USA.
Department of Biostatistics, Division of Quantitative Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Support Care Cancer. 2021 May;29(5):2305-2317. doi: 10.1007/s00520-020-05882-3. Epub 2020 Nov 15.
Antiresorptive drugs (ARD) are associated with a known serious adverse event, known as medication-related osteonecrosis of the jaws (MRONJ). Transition from one ARD to another has become common clinical practice with the advent of more potent or safer agents; however, the influence of sequential antiresorptive therapy as a risk factor for MRONJ has not been established.
To investigate the prevalence of MRONJ in oncology or osteoporosis patients treated with two or more sequential ARDs as opposed to a single antiresorptive drug.
Systematic electronic literature searches were conducted using Ovid MEDLINE, Ovid EMBASE, and Cochrane Central Register of Controlled Trials. Two review authors retrieved studies using pre-determined eligibility criteria and conducted quality assessment and data extraction. Fixed or random-effects meta-analysis models were used to summarize relative estimates for prevalence of MRONJ.
A total of 483 titles and abstracts were screened, and 18 full texts were retrieved for review. Twelve studies were included in the final qualitative and quantitative synthesis. Random effects meta-analysis models revealed a weighted pooled MRONJ prevalence of 19% (95% CI 10-27%) for sequential pamidronate-zoledronate therapy, 10% (95% CI 3-22%) for sequential ibandronate-zoledronate therapy. Pooled weighted prevalence of MRONJ was 13% (95% CI 3-22%) for sequential bisphosphonate-denosumab therapy while bisphosphonates only was 5% (95% CI 0-9%) and denosumab only was 4% (95% CI 3-5%).
The present systematic review suggests an increased prevalence of MRONJ associated with sequential ARD therapy for pamidronate-zoledronate and bisphosphonate-denosumab administration when compared to single ARD therapy.
抗吸收药物（ARD）与一种已知的严重不良事件有关，即药物相关性颌骨坏死（MRONJ）。随着更有效或更安全药物的出现，从一种 ARD 过渡到另一种 ARD 已成为常见的临床实践；然而，连续抗吸收治疗作为 MRONJ 的危险因素的影响尚未确定。
调查与单一抗吸收药物相比，接受两种或更多连续 ARD 治疗的肿瘤或骨质疏松症患者的 MRONJ 患病率。
使用 Ovid MEDLINE、Ovid EMBASE 和 Cochrane 对照试验中心注册库进行系统电子文献检索。两名综述作者使用预先确定的合格标准检索研究，并进行质量评估和数据提取。使用固定或随机效应荟萃分析模型来总结 MRONJ 患病率的相对估计值。
共筛选出 483 个标题和摘要，检索了 18 篇全文进行综述。最终定性和定量综合分析共纳入 12 项研究。随机效应荟萃分析模型显示，连续帕米膦酸盐-唑来膦酸盐治疗的 MRONJ 加权总患病率为 19%（95%CI 10-27%），连续伊班膦酸盐-唑来膦酸盐治疗的 MRONJ 加权总患病率为 10%（95%CI 3-22%）。连续双膦酸盐-地舒单抗治疗的 MRONJ 加权总患病率为 13%（95%CI 3-22%），而双膦酸盐单独治疗的患病率为 5%（95%CI 0-9%），地舒单抗单独治疗的患病率为 4%（95%CI 3-5%）。
本系统评价表明，与单一 ARD 治疗相比，帕米膦酸盐-唑来膦酸盐和双膦酸盐-地舒单抗连续 ARD 治疗与 MRONJ 患病率增加相关。
