New and Old Therapeutics for Oral Ulcerations

Bruce, Alison J.; Rogers, Roy S.

doi:10.1001/archderm.143.4.519

Cited by 17 publications

(19 citation statements)

References 46 publications

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“…From the above, it is evident that there is considerable potential for use of biologics in oral medicine, but there are also a number of hurdles to progress. Apart from adverse effects and cost, further studies, ideally RCTs, are required to better define the use of biologics in oral ulcerative conditions, despite the recognised difficulties in recruiting adequate patient numbers and the needs for improved study design and reporting (Bruce and Rogers, 2007; Baccaglini et al , 2011). Collaborative strategies could also provide additional data to support and guide future use, such as already reported for the use of thalidomide in aphthous ulceration where similar difficulties in trial recruitment exist (Hello et al , 2010).…”

Section: Discussion and The Futurementioning

confidence: 99%

Biologics in oral medicine: ulcerative disorders

O’Neill¹,

Scully²

2012

Oral Diseases

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Inflammatory ulcerative diseases of the oral mucosa are wide ranging but include especially aphthous and aphthous-like ulceration, vesiculobullous disorders and erosive lichen planus (LP). While most patients with these conditions respond to conventional topical and/or systemic immunosuppressive agents, treatment-resistant cases remain challenging. In these, the use of biologics such as tumour necrosis factor alpha (TNF-α) inhibitors or rituximab may be of benefit. This article reviews the use of biologics in ulcerative oral conditions, highlighting potential benefits, adverse effects and principles of use and future developments. TNF-α inhibitors such as infliximab can be effective in inducing resolution in oral aphthous and aphthous-like ulcers and may be an appropriate therapy in those patients in which disease is severe and refractory to, or patients are intolerant of, traditional immunomodulatory regimens. There would also seem support and rationale for use of biologics (mainly rituximab) in pemphigus but not in oral LP or other oral ulcerative conditions.

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Section: Discussion and The Futurementioning

confidence: 99%

Biologics in oral medicine: ulcerative disorders

O’Neill¹,

Scully²

2012

Oral Diseases

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“…Although it is common in such instances to welcome further controlled studies to better define such a role, and to provide a genuine evidence‐basis for use, at present no such studies in aphthous ulceration are available (with the exception of that of Melikoglu et al. 17 ) or in progress, and the difficulties in recruiting patients for such studies are well recognised 7 . As such, the data presented here may represent the best available data to support the use of TNF‐α antagonists in those patients where their ulceration is severe enough to require systemic agents when other approaches are exhausted, that is, ulceration is resistant to these agents or where adverse effects of such preclude prescription or demand treatment discontinuation.…”

Section: Discussionmentioning

confidence: 99%

“…As such, use of alternative steroid‐sparing agents is preferred for disease control. Reported agents used include colchicine dapsone, methotrexate, ciclosporin and thalidomide 1,3,7–9 . Of these, only thalidomide has been validated in randomized controlled trials (RCTs) as being effective in inducing ulcer resolution in severe RAS, BD and HIV‐associate aphthosis 10–12 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of tumour necrosis factor‐α antagonists in aphthous ulceration: review of published individual patient data

O’Neill¹

2011

Acad Dermatol Venereol

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Evidence for efficacy of TNF-α antagonists in aphthous ulceration infection is limited. Such data suggest that in patients with severe aphthous ulceration TNF-α antagonists have some efficacy in inducing ulcer resolution and reducing recurrence. These agents may represent an option in severe refractory aphthosis, although in the absence of controlled studies, caution is advocated if use is to be considered.

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“…The best treatment for OLP includes the use of high-potency topical corticosteroids (Setterfield 2000, Bruce 2007). …”

Section: Oral Lichen Planus (Olp)mentioning

confidence: 99%