Massaad Jean, Magremanne Michèle
Department of oral and maxillofacial surgery, Cliniques universitaires Saint-Luc, Avenue Hippocrate,10, 1200, Brussels, Belgium.
Heliyon. 2024 Oct 5;10(20):e38566. doi: 10.1016/j.heliyon.2024.e38566. eCollection 2024 Oct 30.
MRONJ is a well-known side effect of antiresorptive and antiangiogenic drug treatment. Crohn's disease involves pro-inflammatory interleukins IL-12 and IL-23. Ustekinumab is a targeted therapy antagonist of the p40 subunit of IL-12 and -23 indicated in the treatment of immune-mediated inflammatory diseases. A 72-year-old man with Crohn's disease developed MRONJ after being treated with ustekinumab for four years. The patient presented with bone exposure three months after the extraction of two mandibular teeth. He had no known predisposing factors and never received ARDs. The patient underwent surgical treatment, and ustekinumab treatment was suspended for six months. No recurrence of MRONJ was detected after 12 months. Although the new definition of MRONJ excludes antiangiogenic molecules, tyrosine kinase inhibitors, and mTOR inhibitors alone, some cases have been reported with ustekinumab. This report highlights the possibility of MRONJ occurring when taking ustekinumab for Crohn's disease, even without being treated with antiresorptive drugs.
下颌骨坏死是抗吸收和抗血管生成药物治疗的一种众所周知的副作用。克罗恩病涉及促炎性白细胞介素IL-12和IL-23。乌司奴单抗是一种靶向治疗药物，可拮抗IL-12和IL-23的p40亚基，用于治疗免疫介导的炎性疾病。一名72岁的克罗恩病男性患者在接受乌司奴单抗治疗四年后发生了下颌骨坏死。该患者在拔除两颗下颌牙三个月后出现骨暴露。他没有已知的诱发因素，也从未接受过抗吸收药物治疗。该患者接受了手术治疗，乌司奴单抗治疗暂停了六个月。12个月后未检测到下颌骨坏死复发。尽管下颌骨坏死的新定义仅排除抗血管生成分子、酪氨酸激酶抑制剂和mTOR抑制剂，但已有一些使用乌司奴单抗导致下颌骨坏死的病例报道。本报告强调了即使未接受抗吸收药物治疗，克罗恩病患者服用乌司奴单抗时发生下颌骨坏死的可能性。
