SynthesisSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2025
Ozone therapy as an adjunctive strategy for MRONJ in oncology patients: A systematic review and meta-analysis.
Synthesis in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
Funding
Abstract
purposeMedication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with antiresorptive and antiangiogenic therapies, particularly in oncology patients. Ozone therapy has been proposed as a supportive treatment due to its antimicrobial and tissue-regenerative properties, but its clinical efficacy remains uncertain.
methodsThis systematic review and meta-analysis, registered in PROSPERO (CRD42025631661), followed PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, Cochrane Library, and gray literature. We included clinical studies using ozone therapy in adults with MRONJ. Studies combining ozone with other experimental interventions were excluded. Data on patient characteristics, protocols, and outcomes were extracted. A meta-analysis of proportions was performed using a random-effects model with logit transformation and Hartung-Knapp adjustment. Risk of bias was assessed using Joanna Briggs Institute tools.
resultsSix studies involving 178 patients (65.7% female; mean age ~ 65.9 years) were included. Ozone therapy was administered in gaseous or oil-based formulations, with varied frequencies and application methods. The pooled clinical success rate was 71% (95% CI: 55%-84%), with moderate heterogeneity (I
conclusionsOzone therapy may be associated with clinical benefits in MRONJ management. However, the evidence is of very low certainty due to methodological limitations and heterogeneity. Randomized clinical trials with standardized protocols are needed to clarify its role in supportive care.
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