Interventions for treating oral lichen planus

Summary

Interventions for treating oral lichen planus

Oral lichen planus is a long-term, painful, disease of ulcers on the mouth lining of unknown cause. There is no cure and treatment is given to reduce the pain. Many therapies have been tried but this review found that only a few had ever been compared against placebo and no agent’s effectiveness had been confirmed in separate studies. All studies reported that treatment was effective but the uncertainty was high because of the small patient numbers. Toxic side-effects were only seen in agents taken internally (systemic) as opposed to those applied to the mouth surface.

Abstract

Background

Oral lichen planus (OLP) is a chronic autoimmune disease of unknown aetiology that affects the inner surface of the mouth. The symptomatic forms are painful, tend to worsen with age and with remissions being rare. Current treatment is palliative and not curative, many topical and systemic agents have been tried with little hard evidence for efficacy.

Objectives

To assess the effectiveness and safety of any form of palliative therapy against placebo for the treatment of symptomatic oral lichen planus.

Search strategy

Electronic databases (Cochrane Oral Health Group’s Trials Register, MEDLINE, EMBASE, Best Evidence 2), handsearching of conference proceedings and specific journals, researchers in the field, drug manufacturers. No language restrictions were applied. Most recent search: December 1998.

Selection criteria

Any placebo-controlled trial of palliative therapy for symptomatic oral lichen planus, using a randomised or quasi-randomised design that measured changes in symptoms or clinical signs or both.

Data collection and analysis

Change in symptoms (pain, discomfort) and clinical signs (visual impression, lesion measurements) at the end of therapy. Odds ratio of improvement versus no improvement for each trial outcome and pooling where appropriate.

Main results

A total of nine randomised controlled trials (RCTs) were identified. The nine interventions were grouped into four separate classes (cyclosporines, retinoids, steroids and phototherapy) for comparison. No therapy was replicated exactly, the closest replication involved two trials using high and low dose cyclosporine mouthwash. Only trials recording the same outcomes in each therapeutic class were pooled. The largest number of pooled trials was three. Large odds ratios with very wide confidence intervals indicating a statistically significant treatment benefit were seen in all trials. However this has to be tempered by considerations of the small study sizes, the lack of replication, the difficulty in measuring outcome changes and the very high likelihood of publication bias. Only systemic agents were associated with treatment toxicities, all other side-effects were mild and mainly limited to local mucosal reactions.

Authors’ conclusions

The review provides only weak evidence for the superiority of the assessed interventions over placebo for palliation of symptomatic OLP. The results highlight the need for larger placebo-controlled RCTs with more carefully selected and standardised outcome measures before between-treatment comparisons can be properly interpreted