TY - JOUR
T1 - Medication-related osteonecrosis of the jaw in patients treated concurrently with antiresorptive and antiangiogenic agents
T2 - Systematic review and meta-analysis
AU - Srivastava, Akanksha
AU - Nogueras Gonzalez, Graciela M.
AU - Geng, Yimin
AU - Won, Alexander M.
AU - Myers, Jeffrey
AU - Li, Yisheng
AU - Chambers, Mark S.
N1 - Funding Information:
Source of Support: The salary for Graciela M. Nogueras Gonzalez is partly supported by the Cancer Center Support Grant (NCI Grant P30 CA016672). Conflict of Interest: None.
Publisher Copyright:
© 2021, Innovative Healthcare Institute. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a known adverse event related to the use of antiresorptive (AR) drugs. More recently, an association between antiangiogenic (AA) drugs and MRONJ has been suggested. This review aimed to investigate the overall prevalence and relative risk of MRONJ in patients treated concurrently with AA and AR agents in comparison with a single AA or AR drug. Methods: A review protocol was registered with PROSPERO (ID: CRD42020214244). A systematic literature search, study selection, quality assessment, and data extraction were carried out following PRISMA guidelines. Random-effects meta-analysis models were used to summarize relative estimates for the outcomes, namely prevalence and relative risk of MRONJ. Exposure variable included type of drug, specifically AA and AR agents administered either concurrently or individually. Results: Eleven studies were included in the final qualitative and quantitative syntheses. The overall pooled weighted prevalence of MRONJ with concurrent AA-AR drugs was 6% (95% CI: 3–8%), compared with 0% (95% CI: 0–0%) for AA only and 5% (95% CI: 0–10%) for AR only. However, high heterogeneity was noted among included studies. Retrospective cohort studies showed a higher pooled prevalence of 13% (95% CI: 10–17%) for concurrent AA-AR therapy. The pooled risk ratio for MRONJ revealed a risk with concurrent AA-AR drugs 2.57 times as high as with AR only (95% CI: 0.84–7.87); however, this difference was not statistically significant. Concurrent AA-AR drugs had a risk for MRONJ 23.74 times as high as with AA only (95% CI: 3.71–151.92). Conclusions: High-quality, representative studies are needed for accurate estimation of relative risk of MRONJ with concurrent AA and AR therapy.
AB - Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a known adverse event related to the use of antiresorptive (AR) drugs. More recently, an association between antiangiogenic (AA) drugs and MRONJ has been suggested. This review aimed to investigate the overall prevalence and relative risk of MRONJ in patients treated concurrently with AA and AR agents in comparison with a single AA or AR drug. Methods: A review protocol was registered with PROSPERO (ID: CRD42020214244). A systematic literature search, study selection, quality assessment, and data extraction were carried out following PRISMA guidelines. Random-effects meta-analysis models were used to summarize relative estimates for the outcomes, namely prevalence and relative risk of MRONJ. Exposure variable included type of drug, specifically AA and AR agents administered either concurrently or individually. Results: Eleven studies were included in the final qualitative and quantitative syntheses. The overall pooled weighted prevalence of MRONJ with concurrent AA-AR drugs was 6% (95% CI: 3–8%), compared with 0% (95% CI: 0–0%) for AA only and 5% (95% CI: 0–10%) for AR only. However, high heterogeneity was noted among included studies. Retrospective cohort studies showed a higher pooled prevalence of 13% (95% CI: 10–17%) for concurrent AA-AR therapy. The pooled risk ratio for MRONJ revealed a risk with concurrent AA-AR drugs 2.57 times as high as with AR only (95% CI: 0.84–7.87); however, this difference was not statistically significant. Concurrent AA-AR drugs had a risk for MRONJ 23.74 times as high as with AA only (95% CI: 3.71–151.92). Conclusions: High-quality, representative studies are needed for accurate estimation of relative risk of MRONJ with concurrent AA and AR therapy.
KW - Antiangiogenic drugs
KW - Antiresorptive drugs
KW - Bisphosphonates
KW - Denosumab
KW - Osteonecrosis
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U2 - 10.36401/JIPO-21-14
DO - 10.36401/JIPO-21-14
M3 - Review article
C2 - 35665023
AN - SCOPUS:85117471543
SN - 2666-2345
VL - 4
SP - 196
EP - 207
JO - Journal of Immunotherapy and Precision Oncology
JF - Journal of Immunotherapy and Precision Oncology
IS - 4
ER -