Drug holiday clinical relevance verification for antiresorptive agents in medication-related osteonecrosis cases of the jaw
Drug holiday clinical relevance verification for antiresorptive agents in medication-related osteonecrosis cases of the jaw
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DOI：
10.1007/s00774-019-01035-7
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发表时间：
2020-01-01
影响因子：
3.3
通讯作者：
Umeda, Masahiro
中科院分区：
文献类型：
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作者：
Hayashida, Saki;Yanamoto, Souichi;Umeda, Masahiro
药物相关性颌骨坏死(MRONJ)的治疗策略存在争议。最近，手术治疗被报道优于非手术治疗，但在MRONJ治疗期间停止使用抗吸收药物的作用尚不清楚。本研究旨在评估药物假期在MRONJ病例中的疗效和治疗策略。2009年至2017年在9家医院接受治疗的427名MRONJ患者纳入了这项多中心回顾研究。多因素COX回归分析显示，原发病(骨质疏松或恶性肿瘤)、糖尿病、血清白蛋白、治疗方法(手术或非手术)与治愈率显著相关。手术治疗组和非手术治疗组1年累计治愈率分别为64.7%和18.2%。然而，在整个队列中，或在230名患者中，在停止和继续服用抗吸收药物进行倾向评分匹配后，停用抗吸收药物并不影响治疗结果。按治疗方法分层时，非手术治疗的骨质疏松症患者停用抗吸收药可显著提高治愈率。在接受非手术治疗的恶性肿瘤患者中，停用抗吸收药与更好的治疗结果相关，但没有统计学意义。相比之下，药物假期对接受手术治疗的骨质疏松症和恶性肿瘤患者的预后没有改善作用。因此，无论原发病如何，在治疗MRONJ期间停用抗吸收药物可能不是必要的，在某些情况下可能是有帮助的。未来的前瞻性试验应该进一步研究这个问题。
Treatment strategies of medication-related osteonecrosis of the jaw (MRONJ) are controversial. Recently, surgical treatment has been reported as superior to nonsurgical treatment, but the contribution discontinued antiresorptive agent use during MRONJ treatment remains unclear. This study aimed to evaluate the efficacy of drug holidays and treatment strategies in MRONJ cases. Four-hundred and twenty-seven patients with MRONJ treated at nine hospitals from 2009 to 2017 were included in this multicenter retrospective study. Multivariate Cox regression analysis showed that the primary disease (osteoporosis or malignant tumor), diabetes, serum albumin, and treatment method (surgical or nonsurgical) were significantly correlated with the cure rate. The cumulative 1-year cure rates in the surgical and nonsurgical treatment groups were 64.7% and 18.2%, respectively. However, discontinuing antiresorptive agents did not influence the treatment outcome in the cohort overall, or in 230 patients after performing propensity score matching among the discontinuation and continuation groups. When stratifying by treatment method, antiresorptive agent discontinuation significantly increased the cure rate in patients with osteoporosis who underwent nonsurgical treatment. In patients with malignant tumors undergoing nonsurgical therapy, discontinuing the antiresorptive agent was associated with a better treatment outcome, but not with statistical significance. In contrast, drug holidays showed no effect on improving outcomes in patients with both osteoporosis and malignant tumors who underwent surgical therapy. Thus, regardless of the primary disease, discontinuing antiresorptive agents during treatment for MRONJ may not be necessary and may be helpful in some cases. Future prospective trials should examine this question further.