Predictors of Treatment Response to Pentoxifylline and Tocopherol in Patients with Medication-Related Osteonecrosis of the Jaw

Background/Objectives: Pentoxifylline and tocopherol (PENTO) have been proposed as a conservative therapeutic option for selected patients with medication-related osteonecrosis of the jaw (MRONJ); however, factors associated with favorable clinical outcomes during PENTO therapy have not been clearly established. The objective of this study was to evaluate clinical factors associated with treatment outcomes in patients with MRONJ receiving PENTO therapy. Methods: This prospective observational study included 43 patients with 63 MRONJ lesions treated with PENTO. Demographic and clinical variables were analyzed, including smoking status, underlying disease, type of antiresorptive therapy, and MRONJ stage. Clinical outcomes were assessed during follow-up and categorized according to predefined healing criteria. Logistic regression analysis was performed to identify factors associated with complete healing. Results: Clinical outcomes varied according to patient characteristics. Non-smoking status was associated with a significantly higher probability of complete healing compared with smoking. Patients diagnosed with breast cancer demonstrated less favorable outcomes than other diagnostic groups. Advanced MRONJ stage was associated with a reduced likelihood of complete healing, whereas the type of intravenously administered bisphosphonate was not significantly associated with treatment outcome. In multivariable analysis, smoking status, MRONJ stage, and breast cancer diagnosis were independently associated with complete healing following PENTO therapy. Conclusions: Smoking, breast cancer, and advanced MRONJ stage were associated with a less favorable response to PENTO therapy. The type of intravenously administered bisphosphonate did not significantly influence treatment success. These findings suggest that selected clinical characteristics may be associated with treatment response among patients receiving PENTO therapy. However, the results should be interpreted cautiously owing to the study design and limited sample size.