Apremilast in oral lichen planus – a multicentric, retrospective study

Abstract

Dear Editors, oral lichen planus (OLP) is an autoimmune-mediated inflammatory disease of the oral cavity with an estimated global prevalence of about 1.0 % [1]. Mildly affected individuals may only display the characteristic clinical features, that is, Wickham's striae of the oral mucosa, but are otherwise asymptomatic. However, certain patients may suffer from moderate to severe pain that interferes with food intake and dental hygiene [2]. Furthermore, patients with OLP are more likely to develop oral squamous cell carcinoma with a recently reported malignant transformation rate of 2.3 % [3]. Apremilast, a well-tolerated phosphodiesterase-4-inhibitor, was shown to be effective in some difficult-to-treat OLP cases (six patients in total) [4][5][6][7].In this retrospective, multicenter cohort study, performed in three European tertiary referral hospitals (

Therapeutic strategies for oral lichen planus: State of the art and new insights

“…The effective use of apremilast in erosive OLP was reported firstly only in case reports and case series ( 22 , 23 ). Furthermore, a multicentric, retrospective study on 11 OLP patients (8 of them with a coexistent cutaneous LP) was recently published ( 24 ). In this study, the authors reported that 55% of patients had an improvement of their symptoms at week 12 ( 24 ).…”

“…Furthermore, a multicentric, retrospective study on 11 OLP patients (8 of them with a coexistent cutaneous LP) was recently published ( 24 ). In this study, the authors reported that 55% of patients had an improvement of their symptoms at week 12 ( 24 ). Reasons for therapy discontinuation were progression of disease in five patients (45%), adverse events in three patients (27%), and remission of disease in one (9%) patient ( 24 ).…”

“…Reasons for therapy discontinuation were progression of disease in five patients (45%), adverse events in three patients (27%), and remission of disease in one (9%) patient ( 24 ). The authors concluded that apremilast was effective in some of patients, making its use in recalcitrant cases a possible therapeutic option ( 24 ).…”

Evolving utility of apremilast in dermatological disorders for off-label indications

“…[24][25][26][27] A multicentre retrospective study observed clinical response in only 6 of 11 patients with oral LP after 12 weeks. 28 A case series of five patients with lichenoid and interface dermatitis observed treatment response after 12 weeks in all five patients; however, one patient had to discontinue after 11 months due to toxicity (diarrhoea and upper respiratory tract infection). Larger RCTs assessing role of apremilast in LP are lacking.…”

“…A few case reports and small case series have reported favourable outcomes in mucosal LP, including erosive gingivitis and oesophageal lesions, and in patients with histological findings of lichenoid and interface dermatitis 24–27 . A multicentre retrospective study observed clinical response in only 6 of 11 patients with oral LP after 12 weeks 28 . A case series of five patients with lichenoid and interface dermatitis observed treatment response after 12 weeks in all five patients; however, one patient had to discontinue after 11 months due to toxicity (diarrhoea and upper respiratory tract infection).…”