TY - JOUR
T1 - Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders
T2 - An Umbrella Review of Systematic Reviews
AU - De la Torre Canales, Giancarlo
AU - Câmara-Souza, Mariana Barbosa
AU - Ernberg, Malin
AU - Al-Moraissi, Essam Ahmed
AU - Grigoriadis, Anastasios
AU - Poluha, Rodrigo Lorenzi
AU - Christidis, Maria
AU - Jasim, Hajer
AU - Lövgren, Anna
AU - Christidis, Nikolaos
N1 - © 2024. The Author(s).
PY - 2024/7
Y1 - 2024/7
N2 - 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.
AB - 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.
KW - Botulinum Toxins, Type A/therapeutic use
KW - Humans
KW - Masticatory Muscles/drug effects
KW - Neuromuscular Agents/therapeutic use
KW - Systematic Reviews as Topic
KW - Temporomandibular Joint Disorders/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85196413162&partnerID=8YFLogxK
U2 - 10.1007/s40265-024-02048-x
DO - 10.1007/s40265-024-02048-x
M3 - Article
C2 - 38900335
AN - SCOPUS:85196413162
SN - 0012-6667
VL - 84
SP - 779
EP - 809
JO - Drugs
JF - Drugs
IS - 7
ER -