Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China.
Department of Breast Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Spec Care Dentist. 2024 Mar-Apr;44(2):530-541. doi: 10.1111/scd.12877. Epub 2023 May 23.
This study aimed to assess the overall incidence of osteonecrosis of the jaw (ONJ) caused by bisphosphonates and denosumab when used for controlling bone cancer metastasis or as adjuvant therapy.
A systematic search of the PubMed, Embase, and Cochrane Library databases and major meetings' proceedings as of July 30, 2022, identified randomized controlled trials (RCTs) and observational trials that evaluated ONJ caused by denosumab or bisphosphonates. The total incidence and risk ratio (RR) for ONJ were calculated using a random-effects model.
A total of 42 003 patients with various solid tumors reported in 23 RCTs were included. The overall ONJ incidence in cancer patients receiving denosumab or bisphosphonates was 2.08% (95% CI 1.37-2.91; p < .01; I = 94.99%). Patients receiving denosumab had a higher ONJ incidence than those receiving bisphosphonates (RR 1.64, 95% CI 1.10-2.44; p < .05; I = 65.4%). Subgroup analyses showed that prostate cancer patients receiving denosumab and receiving zoledronic acid had the highest ONJ incidences, 5.0% and 3.0%, respectively. The incidence of ONJ induced by different doses was also different.
The incidence of ONJ caused by denosumab and bisphosphonates is low, the dose of the drug and the type of cancer have certain influence on ONJ. Therefore, clinicians should use the drug reasonably to improve the quality of life of patients.
本研究旨在评估双膦酸盐和地舒单抗用于控制骨癌转移或辅助治疗时引起的颌骨坏死（ONJ）的总体发生率。
系统检索了截至 2022 年 7 月 30 日的 PubMed、Embase 和 Cochrane Library 数据库以及主要会议的会议记录，以确定评估地舒单抗或双膦酸盐引起的 ONJ 的随机对照试验（RCT）和观察性试验。使用随机效应模型计算 ONJ 的总发生率和风险比（RR）。
共纳入了 23 项 RCT 中报告的 42003 例各种实体瘤患者。接受地舒单抗或双膦酸盐治疗的癌症患者的总体 ONJ 发生率为 2.08%（95%CI 1.37-2.91；p<0.01；I²=94.99%）。接受地舒单抗治疗的患者发生 ONJ 的风险高于接受双膦酸盐治疗的患者（RR 1.64，95%CI 1.10-2.44；p<0.05；I²=65.4%）。亚组分析显示，接受地舒单抗治疗的前列腺癌患者和接受唑来膦酸治疗的患者的 ONJ 发生率最高，分别为 5.0%和 3.0%。不同剂量引起的 ONJ 发生率也不同。
地舒单抗和双膦酸盐引起的 ONJ 发生率较低，药物剂量和癌症类型对 ONJ 有一定影响。因此，临床医生应合理使用药物，提高患者的生活质量。
