Abstract
Introduction: Denosumab is indicated in oncology to reduce tumoral development. However, this medication may cause osteonecrosis of the jaw, especially after dental extractions. Drug holiday has been proposed to decrease the risk of osteonecrosis of the jaw. This survey aimed to assess the management of drug holidays for patients who needed both dental extraction and denosumab. Methods: A questionnaire was sent to a panel of healthcare professionals. Results: Of the 33 practitioners interviewed, 28 undertook or “were used to” dental extractions in patients on denosumab. 25% (7/28) of the practitioners questioned did not stop patients from taking denosumab before dental extraction and 75% (21/28) used a drug holiday. For those who stopped the treatment, 33% (7/21) waited 2 months before performing dental extraction and 38% (8/21) waited 2 months after the dental extraction before reintroducing the molecule; 2 months being the median duration in both cases. In addition, 89% (25/28) of practitioners, modified their surgical procedure for these patients. Conclusion: Despite a small number of responders, it seemed that a drug holiday of at least 2 months is mandatory before performing tooth extraction. The issue of the drug holiday should always be raised with the patient's oncologist.
Highlights
Denosumab is a human monoclonal antibody indicated in oncology and administered by subcutaneous injection at 120 mg every 4 weeks [1]
The median time interval was 2 months, and the average 2.21 months. 25 out of 28 people questioned modified their surgical procedure for these patients (Fig. 2f)
The recommendation for a dental extraction procedure is already known for patients on denosumab
Summary
Denosumab is a human monoclonal antibody indicated in oncology and administered by subcutaneous injection at 120 mg every 4 weeks [1] This drug prevents bone complications in adult patients with advanced malignancy with bone involvement, for patients with giant cell bone tumors unresectable or for which surgical resection is likely to cause severe morbidity [2]. It interferes in RANKL/RANK complex by playing osteoprotegerin role which conduce to inhibit osteoclastic activity and to stop bone resorption [3]. It reduces bone remodeling via its anti-osteoclastic activity, but osteoclasts are necessary for the socket’s healing by remodeling the new bone matrix with a peak of activity at the 14th day after the dental extraction
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