Sir, of late, monoclonal antibodies including tocilizumab and sarilumab have been utilised in the treatment of COVID-19. Both drugs were used in more than 3,900 COVID-19 cases in 15 countries worldwide, with encouraging results.1 A randomised controlled trial reported a significant difference in mortality rate between the group receiving tocilizumab (28%) or sarilumab (22%) compared to those receiving standard care (35.8%).1,2 Both act against interleukin-6 receptors and are commonly used in the treatment of rheumatoid arthritis. There has also been some evidence to associate tocilizumab with medication-related osteonecrosis of the jaw (MRONJ).3,4 While other monoclonal antibodies such as denosumab have been proven to be truly associated with MRONJ, we must take into account the potential effects in relation to oral health. In light of this, readers should be aware of the increased use of tocilizumab and sarilumab, as they may encounter a higher number of patients requiring dental extractions with an increased risk of MRONJ in the future. Even though further studies are required, it is worth keeping this in mind as a possible impact of the pandemic.
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Bindakhil M A, Mupparapu M. Osteomyelitis of the mandible exhibiting features of medication-related osteonecrosis in a patient with history of tocilizumab treatment. J Orofac Sci 2018; 10: 53-55.
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Hasan, A., Alraisi, S. MRONJ and COVID-19 caution. Br Dent J 230, 59–60 (2021). https://doi.org/10.1038/s41415-021-2616-9
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DOI: https://doi.org/10.1038/s41415-021-2616-9