Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis

• Published in: Supportive care in cancer Vol. 29; no. 5; pp. 2305 - 2317
• Main Authors: Srivastava, Akanksha, Nogueras Gonzalez, Graciela M., Geng, Yimin, Won, Alexander M., Cabanillas, Maria E., Naing, Aung, Myers, Jeffrey N., Li, Yisheng, Chambers, Mark S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2021; Springer; Springer Nature B.V
• Subjects: Analysis; Bisphosphonate-Associated Osteonecrosis of the Jaw - drug therapy; Bisphosphonate-Associated Osteonecrosis of the Jaw - epidemiology; Bisphosphonates; Bone Density Conservation Agents - pharmacology; Bone Density Conservation Agents - therapeutic use; Bones; Care and treatment; Complications and side effects; Denosumab; Disodium pamidronate; Humans; Immunotherapy; Medicine; Medicine & Public Health; Meta-analysis; Monoclonal antibodies; Necrosis; Nursing; Nursing Research; Oncology; Osteoporosis; Pain Medicine; Prevalence; Rehabilitation Medicine; Review Article; Systematic review; Targeted cancer therapy; Zoledronic acid; Antiresorptive; Targeted therapy; Osteonecrosis; Denosumab; Zoledronate; Bisphosphonates; Skeletal-related events
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05882-3

Background 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. Objectives 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. Material and methods 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. Results 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%). Conclusions 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.