Oral lichen planus: comparative efficacy and treatment costs—a systematic review

Abstract

Objective To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). Materials and methods A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. Results Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. Conclusion Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

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

“…On the one hand, PDT was reported as more effective over dexamethasone mouthwash (70); on the other hand, dexamethasone mouthwash showed a better effectiveness in comparison to PDT (84). Furthermore, two other studies showed a similar efficacy of PDT in comparison to dexamethasone mouthwash and triamcinolone paste 0.1% (71). In comparison to LLL, PDT was more effective in a study conducted on 45 OLP patients (70).…”

“…Indeed, in one study on 34 OLP patients, clobetasol gel 0.05% was more effective than LLL, while, in another one on 42 OLP patients, LLL showed a better effectiveness in comparison to clobetasol gel 0.05% (71,72). Furthermore, dexamethasone solution and triamcinolone paste 0.1% showed higher efficacy than LLL (71,73). The positive effects of LLL on erosions and ulcerations in OLP could be explained by its biological activity on different cells, such as fibroblasts and epithelial cells, which play a pivotal role in the wound healing process (72).…”

“…In comparison to photodynamic therapy (PDT), LLL was less effective in a study conducted on 45 OLP patients ( 70 ). A comparison between topical CS and LLL was also performed, showing variable results ( 71 ). Indeed, in one study on 34 OLP patients, clobetasol gel 0.05% was more effective than LLL, while, in another one on 42 OLP patients, LLL showed a better effectiveness in comparison to clobetasol gel 0.05% ( 71 , 72 ).…”

Detection of anti-desmoglein antibodies in oral lichen planus: What do we know so far

“…The non-erosive type is clinically characterized by white streaks (Wickham´s striae), white plaques, and erythematous lesions, while the erosive type shows multiple painful erosions and ulcerations without well-defined borders and a necrotic base, that impair the quality of life of the patients ( 1 , 2 ). Moreover, non-erosive OLP is usually asymptomatic and mostly responsive to topical therapies with corticosteroid or calcineurin inhibitors ( 3 ). By contrast, the therapy of erosive OLP is extremely tricky.…”

“…By contrast, the therapy of erosive OLP is extremely tricky. Indeed, topical therapies are usually ineffective and patients need systemic therapies, which are mostly off-label, including methotrexate, hydroxychloroquine, and interleukin (IL) antagonists, such as guselkumab (anti-IL23 agent) or secukinumab (anti-IL 17 agent) ( 3 , 4 ). In addition, in erosive OLP a malignant transformation has been reported in up to 5% of the patients ( 5 ).…”