Risk of osteonecrosis of the jaw induced by bone-modifying agents in breast cancer patients with bone metastasis: a network meta-analysis
10.3760/cma.j.cn114015-20240830-00024
- VernacularTitle:骨改良剂致乳腺癌骨转移患者颌骨坏死风险的网状meta分析
- Author:
Yanlan LAI
1
;
Lianghao LI
1
;
Min PAN
1
;
Yufeng LI
1
Author Information
1. 福建医科大学附属口腔医院药剂科，福州 350002
- Publication Type:Journal Article
- Keywords:
Diphosphonates;
Denosumab;
Breast neoplasms;
Bone metastases;
Bisphosphonate-associated osteonecrosis of the jaw;
Network meta-analysis
- From:
Adverse Drug Reactions Journal
2025;27(7):415-421
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically evaluate the risks of osteonecrosis of the jaw induced by bone-modifying agents (BMAs) in breast cancer patients with bone metastasis.Methods:Randomized controlled trials (RCTs) of BMAs in the treatment of breast cancer bone metastasis, in which osteonecrosis of the jaw were evaluated as one of adverse outcome indicators, were collected by searching relevant databases at home and abroad (up to June 25, 2024). Cochrane risk of bias tool was used to evaluate the quality of the included studies. R software (version 4.2.3) was used to conduct Bayesian network meta-analysis, drawing the network evidence plot, the league map of pairwise comparison, and the surface under the cumulative ranking curve for the risks of osteonecrosis of the jaw induced by BMAs in breast cancer patients with bone metastasis, and ranking the risks of osteonecrosis of the jaw caused by different BMAs. The effect sizes of osteonecrosis of the jaw were expressed by hazard risk ( HR) and its 95% confidence interval ( CI). Results:A total of 12 RCTs were included in the analysis, involving 26 047 patients. BMAs were used in 18 503 patients, including zoledronic acid (in 6 202 patients), ibandronate (in 4 817 patients), clodronate (in 3 897 patients), and denosumab (in 3 587 patients); 7 544 patients were treated with placebo or not be intervened. Among 26 047 patients, 272 occurred osteonecrosis of the jaw. The incidence of osteonecrosis of the jaw was 1.44% (267/18 503) in BMA treated patients and 0.07% (5/7 544) in placebo/non-intervention patients, respectively. The results of the network meta-analysis showed that the HR (95% CI) of osteonecrosis of the jaw caused by denosumab, zoledronic acid, ibandronate and clodronate in breast cancer patients with bone metastases were 18.12 (10.03-35.75), 11.42 (6.03-22.86), 5.92 (2.78-13.22) and 2.73 (0.99-7.20), respectively, compared with the patients in the placebo or non-intervention group. Compared with zoledronic acid or denosumab, ibandronate and clodronate had lower risks of inducing osteonecrosis of the jaw. There was no statistically significant difference in the risk of inducing osteonecrosis of the jaw by denosumab and zoledronic acid. Conclusions:Denosumab and zoledronic acid have a higher risk of inducing osteonecrosis of the jaw. Among BMAs, clodronate and ibandronate should be preferred in treatment of breast cancer patients with bone metastasis who have risk factors of osteonecrosis of the jaw.
