目的:颞下颌关节紊乱病(TMD)包括几种引起咀嚼肌(M-TMD)和颞下颌关节疼痛和功能受损的疾病。临床医生和研究人员对使用肉毒杆菌毒素A(BoNT-A)作为M-TMD的治疗有很大的兴趣。然而,由于缺乏关于BoNT-A的疗效和不良事件的一致证据,临床决策具有挑战性。因此,这篇综述旨在系统地评估系统评价(SRs),评估BoNT-A治疗对疼痛强度的影响,下颌运动,和M-TMDs患者的不良事件。
方法:在MEDLINE数据库中进行了电子搜索,EMBASE,CINAHL,Cochrane中央控制试验登记处(CENTRAL),WebofScience,认识论,ClinicalTrials.gov,和ICTRP来确定研究BoNT-A对M-TMD影响的SR,从每个数据库开始到2023年12月6日发布。根据总括审查方法工作组制定的关键评估清单,对证据质量进行了评估。仅包括高质量的SR。
结果:总计,包括18个SR。BoNT-A被证明比安慰剂更有效地减轻疼痛强度,但不能与标准治疗相比。此外,BoNT-A在改善下颌运动方面并不优于安慰剂或标准治疗。与其他治疗相比,BoNT-A被认为对肌肉和骨组织具有更高的不良事件风险。
结论:本综述的综合提供了目前最高水平的证据。一起来看,有迹象表明BoNT-A治疗M-TMD有效,有适度的证据支持。然而,考虑到造成严重不良事件的风险,建议使用BoNT-A治疗是最后的治疗选择。
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.
METHODS: 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.
CONCLUSIONS: 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.