Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews.

IF 13 1区医学 Q1 PHARMACOLOGY & PHARMACY Drugs Pub Date : 2024-07-01 Epub Date: 2024-06-20 DOI:10.1007/s40265-024-02048-x

Giancarlo De la Torre Canales, Mariana Barbosa Câmara-Souza, Malin Ernberg, Essam Ahmed Al-Moraissi, Anastasios Grigoriadis, Rodrigo Lorenzi Poluha, Maria Christidis, Hajer Jasim, Anna Lövgren, Nikolaos Christidis

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Abstract

Objective: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs.

Method: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included.

Results: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments.

Conclusion: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

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治疗肌源性颞下颌关节紊乱症的肉毒杆菌毒素 A：系统综述》。

目的：颞下颌关节紊乱症（TMDs）包括多种会引起疼痛并损害咀嚼肌（M-TMDs）和颞下颌关节功能的疾病。临床医生和研究人员对使用肉毒杆菌毒素-A（BoNT-A）治疗 M-TMD 非常感兴趣。然而，由于缺乏有关 BoNT-A 疗效和不良反应的一致证据，临床决策具有挑战性。因此，本综述旨在系统评估评价 BoNT-A 治疗对 M-TMDs 患者的疼痛强度、下颌运动和不良事件影响的系统性综述（SR）：在 MEDLINE、EMBASE、CINAHL、Cochrane 对照试验中央登记处 (CENTRAL)、Web of Science、Epistemonikos、ClinicalTrials.gov 和 ICTRP 等数据库中进行电子检索，以确定自各数据库建立之初至 2023 年 12 月 6 日期间发表的研究 BoNT-A 对 M-TMDs 影响的 SR。证据质量根据伞式综述方法工作组制定的关键评估清单进行评分。结果：结果：共纳入了 18 篇研究报告。研究表明，BoNT-A 在降低疼痛强度方面比安慰剂更有效，但与标准治疗方法相比效果不佳。此外，在改善下颌运动方面，BoNT-A 也不优于安慰剂或标准疗法。与其他治疗方法相比，BoNT-A 被认为对肌肉和骨骼组织产生不良反应的风险较高：本综述提供了目前最高水平的证据。综合来看，有迹象表明 BoNT-A 对治疗 M-TMDs 有效，并有中等程度的证据支持。然而，考虑到引起严重不良事件的风险，建议将 BoNT-A 作为最后的治疗选择。

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来源期刊

Drugs 医学-毒理学

CiteScore

22.70

自引率

0.90%

发文量

134

审稿时长

3-8 weeks

期刊介绍： Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.