ОПЫТ ИСПОЛЬЗОВАНИЯ ДЕНОСУМАБА В ЛЕЧЕНИИ ПЕРВИЧНО-ХРОНИЧЕСКОГО ОСТЕОМИЕЛИТА ЧЕЛЮСТЕЙ У ДЕТЕЙ

EXPERIENCE OF USING DENOSUMAB IN THE TREATMENT OF PRIMARY CHRONIC OSTEOMYELITIS OF THE JAWS IN CHILDREN

Primary chronic nonbacterial osteomyelitis (PCNBO) represents a relatively uncommon inflammatory bone disease with limited documented cases in medical literature. Most available studies describe small patient cohorts treated with varying therapeutic regimens, often lacking consistent positive outcomes. Recent advancements in medical technology have facilitated the development of innovative pharmacological agents capable of modulating abnormal bone resorption, particularly monoclonal antibodies targeting RANKL (such as denosumab), which have demonstrated considerable therapeutic potential. This study evaluated a combined treatment approach for pediatric PCNBO of the jaws, incorporating surgical intervention with pharmacological management. Between 2016 and 2024, 31 pediatric patients (11 males and 20 females) aged 5 to 15 years were treated at the Department of Maxillofacial Surgery of the Russian Children's Clinical Hospital. The therapeutic protocol involved surgical decortication of affected jaw areas followed by subcutaneous administration of denosumab. Analysis of treatment outcomes revealed several key findings. The patient cohort consisted predominantly of females (64.52%), with a mean age of 9.95±0.634 years. Post-treatment evaluation demonstrated a reduction in relapse frequency among 22.58% of patients, while 38.70% achieved complete remission without subsequent recurrences. Notably, 22.58% of cases maintained their pretreatment relapse rate, whereas 16.12% exhibited increased recurrence frequency following therapy. Quantitative assessment of relapse intervals showed significant improvement, with the mean recurrence-free period extending from 3.20 ± 0.466 months before treatment to 4.654 ± 1.277 months after intervention, representing a 45.4% increase in remission duration. The study findings support the efficacy of combining surgical management with targeted antiresorptive therapy for PCNBO. The observed extension of relapse-free intervals and improved remission rates suggest that this multimodal approach may offer superior clinical outcomes compared to conventional treatments. However, these results highlight the need for further large-scale, multicenter investigations to better understand the underlying pathophysiology of PCNBO and to optimize treatment protocols. Future research should focus on establishing standardized diagnostic criteria and developing evidence-based therapeutic guidelines for this challenging condition. The demonstrated success of RANKL inhibition with denosumab in conjunction with surgical intervention underscores the importance of addressing both the inflammatory and bone remodeling components of PCNBO. This study contributes to the growing body of evidence supporting targeted biological therapies in the management of chronic nonbacterial osteomyelitis, while emphasizing the necessity for continued clinical research in this field. © 2025, Pediatria Ltd.. All rights reserved.