Which monoclonal antibodies cause osteonecrosis of the jaws? An overview of the current literature excluding denosumab

There is a well-documented relationship between the monoclonal antibody (MAB) denosumab and medication-related osteonecrosis of the jaw (MRONJ). However, the association between other MABs and MRONJ remains unclear. A systematic search was conducted across MEDLINE, Embase, and Web of Science to identify articles describing cases of MRONJ associated with the use of MABs excluding denosumab. The Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and case series was used to critically appraise all included studies. Demographics, clinical presentation, risk factors, MRONJ staging as per the American Association of Oral and Maxillofacial Surgeons (2014), treatment modalities, and outcomes were extracted and analysed. A total of 2324 articles were identified and screened, of which 30, describing 32 cases of MRONJ, met the inclusion criteria. In most cases, MRONJ presented at an advanced stage (stage 2 or 3), and it was often precipitated by dental extractions. Bevacizumab was the most common MAB linked to MRONJ, followed by other MABs including infliximab, pembrolizumab, adalimumab, and rituximab. This review demonstrated a broad spectrum of MABs associated with MRONJ and highlights the need for enhanced preventive measures, early diagnosis, and effective management strategies.