Topical Corticosteroids a Viable Solution for Oral Graft versus Host Disease? A Systematic Insight on Randomized Clinical Trials

Abstract

Background and Objectives: This research attempts to provide a clear view of the literature on randomized clinical trials (RCTs) concerning the efficacy of topical dexamethasone, clobetasol and budesonide in oral graft versus host disease (GVHD). Materials and Methods: An electronic search of the PubMed, Web of Science and Scopus databases was carried out for eligible RCTs. Studies were included if they had adult patients with oral GVHD treatment with topical corticosteroids, and if the RCT study was published in English. The Cochrane Risk of Bias tool was used to assess the quality of these studies. Overall, three RCTs were included (an Open, Randomized, Multicenter Trial; a Randomized Double-Blind Clinical Trial; and an Open-Label Phase II Randomized Trial). Results: The trials involved 76 patients, of which 44 patients received topical dexamethasone, 14 patients received topical clobetasol and 18 patients received topical budesonide. Topical agents were most frequently used when oral tissues were the sole site of involvement. It appears that the best overall response is present for budesonide with no difference between the four arms, followed by clobetasol, and then by dexamethasone. The limitation of the current study is mainly represented by the fact that overall response was derived in two of the studies from other parameters. Moreover, both budesonide and clobetasol were used in only one study each, while two assessed dexamethasone. Conclusions: Based on the clinical trials, all three agents seem to be effective in treating oral GVHD and had a satisfactory safety profile. There is still a need for assessing high quality RCTs to assess the efficacy of these therapies on a larger cohort.

Efficacy of adjuvant therapy gingko biloba extract on vitiligo treated by topical desoximetasone to melanin index and vasi score

“…Keratinocytes can produce growth factors such stem cell factor (SCF), endothelin (ET), and basic fibroblast growth factor (bFGF), all of which help melanocytes grow in a continuous manner during melanogenesis. In the end, GB may be able to prevent the onset of vitiligo [22][23][24].…”

Perspectives on oral chronic graft-versus-host disease from immunobiology to morbid diagnoses

“…Dexamethasone (0.5 mg/5ml), clobetasol (0.05-0.025%) or triamcinolone 0.1% are often used ( 35 ). Only one randomized clinical trial has investigated the superior effect of clobetasol (0.05%), in comparison to dexamethasone for oral mucosal cGVHD, with a significant partial to complete response reported for 85% of the patients ( 117 , 172 ). Other immunosuppressants, such as topical tacrolimus 0.1%, showed less effective clinical and histopathological responses compared to topical corticosteroids but is preferably used for lip manifestations ( 35 , 57 , 60 , 117 ).…”