Dissertação
Associação entre a hiperpigmentação da mucosa oral com o uso de mesilato de imatinibe: estudo transversal e revisão sistemática da literatura
Fecha
2019-07-17Autor
Sicília Rezende Oliveira
Institución
Resumen
Hyperpigmented lesions are commonly observed in the oral mucosa. Although they
often present similar clinical characteristics, these lesions present different
etiopathogenesis and diagnosis. Thus, for the correct diagnosis, it is necessary to
investigate the medical history of the patient, use of drugs. Clinical examination and
biopsy may also be necessary. A number of medications can cause pigmentation in
the oral mucosa. The pathogenesis of pigmentation may vary depending on the
causative agent. Chemotherapeutic agents such as Imatinib Mesylate, used in the
treatment of chronic myeloid leukemia and acute lymphoblastic leukemia pH +, may
be associated with the development of hyperpigmented oral lesions in particular in
the hard palate. The objective of this study was to evaluate the association between
hyperpigmentation of the oral mucosa and the use of imatinib mesylate in patients
with leukemia. In addition, we also aimed to compare our data with those obtained
from a systematic review of the literature. The study was approved by the Research
Ethics Committee of the Federal University of Minas Gerais under the protocol
number 48317515.6.0000.5149. A cross-sectional study was conducted with 74
patients undergoing treatment with imatinib mesylate. The sociodemographic
characteristics, clinical history of the patients and data regarding the use of drugs
used during the treatment of leukemia were collected. In addition, an intra-oral
clinical examination and photographic record of the hard palate region were
performed. The association between the use of imatinib mesylate and the presence
of hyperpigmented oral lesions was also investigated. Descriptive statistics, bivariate
analysis and multivariate (Poisson regression) analysis were carried out. In the
Poisson regression, confidence intervals (CI) were provided. A systematic review of
the literature was conducted in the main electronic databases with the objective of
retrieving case reports or case series of patients using imatinib mesylate, who
developed hyperpigmented lesions in the oral mucosa. Among the 74 participants, 41
were male individuals (55.4%) and 33 were female individuals (44.6%). The mean
age of the participants was 49.3 years. Sixty-six (89.2%) patients developed
hyperpigmented lesions in the oral mucosa. In the multivariate analysis, in which
Poisson regression was employed, patients who had used imatinib mesylate for more
than 72 months had a hyperpigmentation score 1.62 (1.12 – 2.33 95% CI) times
greater than those who had used this drug for a shorter period. Patients who had
used Hydroxyurea associated Imatinib Mesylate over a period of more than 30 days
had a hyperpigmentation score 1.43 (1.02 – 2.01 95% CI) times higher than those who
had used this drug for a shorter period. The systematic review of the literature
retrieved 20 clinical cases of patients submitted to treatment with imatinib mesylate
and exhibiting hyperpigmented lesions in the oral mucosa. Based on the analysis of
these data, it was possible to conclude that the development of hyperpigmented oral
lesions was associated with the use of imatinib mesylate. The use of hydroxyurea
seemed to increment this association.