Br J Oral Maxillofac Surg: Tumor Necrotizer-α (TNF-α) inhibitors associated with jaw necrotasia and myelitis: a systematic review

Tumor necrosis α (TNF-α) inhibitors are increasingly being used as immunomodulants to control inflammation such as rheumatoid arthritis and Crohn's disease.
, however, serious side effects of TNF-α inhibitors include an increased incidence of lymphoma and an increased risk of infection, such as tuberculosis.
a systematic review aimed at determining whether TNF-α is linked to drug-related jaw necrotasia (MRONJ), the findings have been published online in Br J Oral Maxillofac Surg.
three authors independently searched the central registry of PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane controlled trials for published reports of oral bone necrosis (ONJ) or myelitis (OM) in patients with published anti-TNF-α drugs and no history of anti-angiogenesic or anti-absorption therapy.
only six were ultimately eligible for analysis, and all studies independently assessed their bias risk.
study included 6 ONJ or OM patients, and the appearance of ONJ or OM was entirely attributable to TNF-α inhibitors.
most common site of onJ is the back of the jawbone (n-5).
the average (SD) time for anti-TNF-α treatment was 62.5 (47.4) months prior to osteopathy.
, invasion surgery was reported to be a trigger for five patients, and five ONJ/OM cases were resolved after conservative treatment.
all studies have a high risk of bias, limited data suggest that some patients may have ONJ/OM as a result of the treatment of TNF-α inhibitors.
now requires higher-quality studies to determine the relative risk of MRONJ occurring in patients taking these drugs.
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