Efficacy of steroidal <i>vs</i> non-steroidal agents in oral lichen planus: a randomised, open-label study

Singh, Aryendra; Rai, Ashutosh; Aftab, M.; Jain, Sachin; Singh, Mamta

doi:10.1017/s0022215116009658

Cited by 39 publications

(41 citation statements)

References 24 publications

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“…Two additional articles were identified by manual searching . Finally, 21 RCTs were included in the analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

“…The time range to evaluate relapse was 2 weeks to 6 months after drug discontinuance. After excluding the studies with unavailable numbers of patients with relapse and no relapse during the observation period, four studies (240 patients) showed no significant difference between tacrolimus and TCS (RR 1·02, 95% CI 0·38–2·72, I 2 = 68%). There was also no material change in the overall combined RR after excluding any single study (range: RR 0·68, 95% CI 0·25–1·81 to RR 1·70, 95% CI 0·93–3·12).…”

Section: Resultsmentioning

confidence: 99%

“…Local adverse events were mainly transient burning or tingling sensation (Table S2; see Supporting Information). When the studies with no adverse events observed and unavailable numbers of adverse events were excluded, tacrolimus–TCS studies showed a statistically higher incidence of local adverse events in the tacrolimus group (RR 2·05, 95% CI 1·27–3·33, I 2 = 0%; Fig. ).…”

Section: Resultsmentioning

confidence: 99%

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Topical calcineurin inhibitors in the treatment of oral lichen planus: a systematic review and meta‐analysis

et al. 2019

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Summary Background TCS (topical corticosteroids) are the first‐line drug in the treatment of oral lichen planus (OLP). However, the value of topical calcineurin inhibitors (TCI) including tacrolimus, pimecrolimus and ciclosporin for OLP is still controversial. Objectives To compare the efficacy and safety of TCI vs. TCS for OLP. Methods The authors searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and four Chinese databases from 1950 to May 2018. The randomized controlled trials comparing TCI and TCS for OLP reported at least one of the following outcomes: improvement of clinical signs and/or symptoms, relapse, blood levels of TCI and adverse events. Results Twenty‐one trials involving 965 patients were included in the analysis. For the treatment of OLP (3–8 weeks), TCI including tacrolimus, pimecrolimus and ciclosporin were similar to TCS in efficacy. Tacrolimus–TCS resulted in similar outcomes, with relapse at 3 weeks to 6 months. Blood levels of TCI were usually undetectable. In addition, tacrolimus showed a statistically higher incidence of local adverse events than TCS for short‐term treatment. A few systemic adverse events occurred in the tacrolimus and ciclosporin groups, but they were not serious. Conclusions The evidence for tacrolimus (n = 12), pimecrolimus (n = 3) and ciclosporin (n = 6) demonstrated that treatment with TCI may be an alternative approach when OLP does not respond to the standard protocols. Tacrolimus 0·1% should be the first drug of choice when selecting TCI for short‐term treatment in recalcitrant OLP. Further well‐designed trials are warranted to evaluate the long‐term efficacy and safety of TCI. What's already known about this topic? The main topical drug for oral lichen planus (OLP) is topical corticosteroids (TCS). Patients with OLP who are not responsive to TCS or are at risk of adverse events from TCS need other alternative drugs. Topical calcineurin inhibitors (TCI), including tacrolimus, pimecrolimus and ciclosporin, have become a hot topic in a variety of mucocutaneous immune‐mediated diseases. What does this study add? TCI including tacrolimus, pimecrolimus and ciclosporin were similar to TCS in efficacy for the short‐term treatment of OLP. The local adverse events of tacrolimus were higher than with TCS. A few systemic adverse events were reported with TCI, but they were all tolerable and not serious. The limited evidence for pimecrolimus (three trials) and ciclosporin (six trials) requires further studies to evaluate the short‐term and long‐term efficacy and safety of TCI compared with TCS.

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“…Two additional articles were identified by manual searching . Finally, 21 RCTs were included in the analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Topical calcineurin inhibitors in the treatment of oral lichen planus: a systematic review and meta‐analysis

et al. 2019

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“…Numerous invasive and non‐invasive therapeutic methods including local/systemic corticosteroids, laser therapy, and surgical intervention for the treatment of OLP are suggested . Cutaneous lesions generally improve spontaneously after therapy; however, OLP requires protracted treatment through steroids and long‐term follow‐up .…”

Section: Introductionmentioning

confidence: 99%

“…5 Numerous invasive and non-invasive therapeutic methods including local/systemic corticosteroids, laser therapy, and surgical intervention for the treatment of OLP are suggested. [6][7][8] Cutaneous lesions generally improve spontaneously after therapy; however, OLP requires protracted treatment through steroids and long-term follow-up. 9 Extended use of corticosteroids for chronic OLP may have certain local and systemic complications, which includes opportunistic candidiasis, mucosal atrophy, adrenal insufficiency, gastrointestinal disorders, hypertension, and diabetes.…”

Section: Introductionmentioning

confidence: 99%

Photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review

Akram

Javed

Hosein

et al. 2017

Photoderm Photoimm Photomed

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Summary Background The aim of this systematic review was to assess the efficacy of photodynamic therapy (PDT) in the treatment of symptomatic oral lichen planus (OLP). Methods This systematic review aimed to address the following focused question: “Is PDT effective in the treatment of symptomatic OLP?” Indexed databases such as MEDLINE, EMBASE, and CENTRAL were searched up to and including August 2017. Results Six clinical studies were included. The risk of bias was considered high in 5 studies and moderate in one study. Parameters of PDT such as wavelengths, energy fluence, power density and exposure time ranged between 320‐660 nm, 120 J/cm2, 130 mW/cm2, and 70‐150 seconds, respectively. The follow‐up period ranged from 4 to 48 weeks. All included studies reporting clinical scores showed that PDT was effective in the treatment of OLP in adult patients at follow‐up. However, PDT did not show significant improvement when compared with steroid therapy. Conclusion Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with long follow‐up period, standardized PDT parameters, and comparing the efficacy of PDT with steroid therapy are warranted to obtain strong conclusions in this regard.

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Oral Acitretin Plus Topical Triamcinolone vs Topical Triamcinolone Monotherapy in Patients With Symptomatic Oral Lichen Planus

Vinay,

Kumar,

Dev

et al. 2024

JAMA Dermatol

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ImportanceSymptomatic oral lichen planus (OLP) can be challenging to treat.ObjectiveTo compare the efficacy of oral acitretin plus topical triamcinolone acetonide (TAC), 0.1%, with TAC monotherapy in patients with symptomatic OLP.Design, Setting, and ParticipantsThis monocentric, investigator-initiated, placebo-controlled, investigator- and patient-blinded randomized clinical trial was conducted from December 2018 to June 2020 at the Postgraduate Institute of Medical Education and Research, a tertiary referral center in Chandigarh, India. Sixty-four patients 18 years or older with symptomatic OLP were recruited by consecutive sampling. Data were analyzed from July to December 2020.InterventionThe patients were randomized to receive either a combination of oral acitretin (25-35 mg/d) and TAC (treatment group) or TAC in combination with placebo (placebo group) for 28 weeks, with an additional 8 weeks of treatment-free follow-up after the end of treatment (36 weeks of total study duration).Main Outcomes and MeasuresThe disease severity and treatment response were assessed using Oral Disease Severity Score (ODSS), Oral Health Impact Profile 14 (OHIP-14), and visual analog scale (VAS). The primary aim was to assess the number of patients achieving ODSS-75 (75% reduction in ODSS compared with baseline) in both groups at 28 weeks and at the end of 36 weeks.ResultsAmong 64 patients, 31 in the treatment group and 30 in the placebo group completed the study (mean [SD] age, 50.6 [15.2] years vs 49.2 [14.4] years; male-female ratio, 13:19 vs 16:16). Baseline ODSS, visual analog scale, and Oral Health Impact Profile 14 scores were comparable in both groups. In the intention-to-treat analysis, there was a statistically significant higher number of patients achieving 75% or higher reduction in ODSS in the treatment group compared with the placebo group at the end of 28 weeks (28 [88%] vs 15 [47%], a 41 [95% CI, 20-61] percentage point difference between groups; P &lt; .001; Cramér V = 0.47) and 36 weeks (27 [84%] vs 13 [41%], a 43 [95% CI, 23-67] percentage point difference between groups; P &lt; .001; Cramér V = 0.47). Relapses during the posttreatment follow-up of 8 weeks were low among patients in both treatment and placebo groups (1 [3%] vs 2 [6%], a 3 [95% CI, −13 to 7] percentage point difference between groups; P &gt; .99; Cramér V = 0.07).Conclusion and RelevanceIn this randomized clinical trial, the combination of oral acitretin and TAC was more effective than TAC monotherapy in patients with symptomatic OLP.Trial RegistrationClinical Trial Registry of India Identifier: CTRI/2018/11/016448

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Efficacy of steroidal vs non-steroidal agents in oral lichen planus: a randomised, open-label study

Abstract: Non-steroidal drugs such as dapsone, tacrolimus and retinoid are as efficacious as steroidal drugs for treating oral lichen planus, and avoid the side effects associated with steroids.

Cited by 39 publications

References 24 publications

Topical calcineurin inhibitors in the treatment of oral lichen planus: a systematic review and meta‐analysis

Topical calcineurin inhibitors in the treatment of oral lichen planus: a systematic review and meta‐analysis

Photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review

Oral Acitretin Plus Topical Triamcinolone vs Topical Triamcinolone Monotherapy in Patients With Symptomatic Oral Lichen Planus

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