Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Oral Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
Sci Rep. 2022 Jul 7;12(1):11545. doi: 10.1038/s41598-022-15720-7.
A drug holiday of 3 months does not promote separation of sequestra and is not correlated with treatment outcomes after surgical therapy in osteoporosis patients who receive antiresorptive agents and who have medication-related osteonecrosis of the jaw. Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect of antiresorptive agents alone or in combination with immune modulators or antiangiogenic medications, in the absence of radiation exposure to the head and neck region. The effectiveness of surgical treatment for MRONJ has been reported, but the timing of the operation remains controversial. The purpose of this study was to clarify whether preoperative drug holidays of antiresorptive agents promote sequestrum separation and improve treatment outcomes in patients who receive low doses of antiresorptive agents. This retrospective study included 173 patients who received low-dose antiresorptive agents and underwent surgical therapy. The effects of a drug holiday on the separation of sequestra and treatment outcomes were analyzed using logistic and Cox regression analyses. Multivariate analysis revealed that administration of an antiresorptive agent for more than 4 years, a high number of lymphocytes, and an extensive osteolytic area were significantly correlated with separation of sequestra, but drug holiday did not promote sequestrum separation. Furthermore, a drug holiday of 90, 120 or 180 days did not show any improvement in treatment outcomes. The drug holiday of the antiresorptive agents for the treatment of MRONJ is unnecessary, and surgical therapy should be performed early.
三个月的停药期并不会促进病灶分离，也与接受抗吸收药物治疗且患有与药物相关的颌骨坏死（MRONJ）的骨质疏松症患者的治疗结果无关。在没有头颈部放射治疗的情况下，单独或联合免疫调节剂或抗血管生成药物使用抗吸收药物会导致颌骨坏死，这是一种严重的不良反应。据报道，手术治疗 MRONJ 是有效的，但手术时机仍存在争议。本研究旨在阐明术前抗吸收药物停药期是否会促进病灶分离并改善接受低剂量抗吸收药物治疗的患者的治疗结果。本回顾性研究纳入了 173 名接受低剂量抗吸收药物治疗并接受手术治疗的患者。使用逻辑回归和 Cox 回归分析来分析药物停药对病灶分离和治疗结果的影响。多变量分析显示，抗吸收药物使用超过 4 年、淋巴细胞数量较多和广泛的溶骨性区域与病灶分离显著相关，但药物停药并未促进病灶分离。此外，药物停药 90、120 或 180 天并未显示治疗结果有任何改善。因此，抗吸收药物治疗 MRONJ 的停药期是不必要的，应尽早进行手术治疗。
