Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: syst
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REVIEW ARTICLE
Prevalence of medication related osteonecrosis of the jaw in patients treated with sequential antiresorptive drugs: systematic review and meta-analysis Akanksha Srivastava 1 & Graciela M. Nogueras Gonzalez 3 & Yimin Geng 4 & Alexander M. Won 2 Maria E. Cabanillas 5 & Aung Naing 6 & Jeffrey N. Myers 7 & Yisheng Li 3 & Mark S. Chambers 2
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Received: 22 July 2020 / Accepted: 5 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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 ibandronatezoledronate 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. Keywords Bisphosphonates . Denosumab . Osteonecrosis . Antiresorptive . Zoledronate . Targeted therapy . Skeletal-related events
* Akanksha Srivastava [email protected]
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Research Medical Library, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Department of Restorative Dentistry & Prosthodontics, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge, Suite 5350, Houston, TX 77054, USA
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Section of Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, Division of Surgery, The University of Texas M.D. Anderson
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