Cochrane · intervention · CD001168
Interventions for treating oral lichen planus: corticosteroid therapies
Lodi, G, Manfredi, M, Mercadante, V, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
58
current version
GRADE rated
35
No studies
1
Included studies
35
as reported
No studies 1 · 1.7%Ungraded 22 · 37.9%Very low 22 · 37.9%Low 13 · 22.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People with symptomatic, biopsy-confirmed OLP; not concurrently receiving other OLP treatment | 35 RCTs, 1474 participants (20 to 139 per study); 7 at low, 10-11 at unclear and 17-18 at high risk of bias |
| Intervention | Any local or systemic corticosteroid treatment | Topical corticosteroids (n=32); systemic corticosteroids (n=2); intralesional corticosteroids (n=2) |
| Comparison | Placebo; calcineurin inhibitor; another corticosteroid; any other local or systemic treatment; the same corticosteroid plus an adjunctive treatment | Placebo (n=3); calcineurin inhibitors (n=11); other corticosteroids (n=8); other treatments (n=9); adjunctive treatments (n=6) |
| Outcomes | Primary: pain (score and resolution) assessed by participants at end of treatment. Secondary: clinical response (score and resolution); adverse effects | Pain (score; resolution); clinical (score; resolution); adverse effects |
| Study designs | Randomised controlled trials (RCTs) only | RCT (n=35) |
| Timing | Measured at the end of the treatment course (between one week and six months) | Treatment courses one week to six months (majority one to two months) |
Search date: 2019-02. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Show all 3 versionsTopical corticosteroid vs Placebo
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical resolution 8-9 weeks | RR 6.00 [0.76, 47.58] 50 per 1000 vs 300 per 1000 | 2 studies · 72 participants | Very low Downgraded: risk of bias, imprecision |
Clinical score end of treatment | MD -0.38 [-0.89, 0.14] | 1 study · 32 participants | Low Downgraded: imprecision |
Adverse effects 3-9 weeks | RR 1.48 [0.48, 4.56] 89 per 1000 vs 132 per 1000 | 3 studies · 88 participants | Very low Downgraded: risk of bias, imprecision |
Pain resolution 8-9 weeks | RR 1.91 [1.08, 3.36] 306 per 1000 vs 584 per 1000 | 2 studies · 72 participants | Low Downgraded: risk of bias, imprecision |
Pain (mean score, 0-10) end of treatment | MD -1.81 [-3.54, -0.09] | 1 study · 32 participants | Low Downgraded: imprecision |
Topical clobetasol propionate vs Topical ciclosporin
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain resolution 3-8 weeks | RR 2.11 [0.76, 5.86] 200 per 1000 (ciclosporin) vs 422 per 1000 | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Clinical resolution 3-8 weeks | RR 3.16 [1.00, 9.93] 150 per 1000 (ciclosporin) vs 474 per 1000 | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects 3-8 weeks | RR 6.32 [0.84, 47.69] 50 per 1000 (ciclosporin) vs 316 per 1000 | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Topical clobetasol propionate vs Topical tacrolimus
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects 3-8 weeks | RR 0.05 [0.00, 0.83] 180 per 1000 (tacrolimus) vs 9 per 1000 | 2 studies · 100 participants | Very low Downgraded: risk of bias, imprecision |
Pain (mean VAS score) end of treatment | MD 0.08 [-0.33, 0.49] | 1 study · 68 participants | Ungraded |
Clinical resolution 3-8 weeks | RR 0.61 [0.38, 0.99] 654 per 1000 (tacrolimus) vs 399 per 1000 | 2 studies · 52 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Pain resolution 3-8 weeks | RR 0.45 [0.24, 0.88] 440 per 1000 (tacrolimus) vs 198 per 1000 | 2 studies · 100 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Topical triamcinolone acetonide vs Topical pimecrolimus
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects end of treatment | RR 0.21 [0.01, 4.10] | 1 study · 35 participants | Ungraded |
Pain (mean VAS score) end of treatment | MD -0.05 [-2.97, 2.87] | 2 studies · 70 participants | Ungraded |
Topical triamcinolone acetonide vs Topical tacrolimus
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects 3-8 weeks | RR 0.47 [0.22, 0.99] 516 per 1000 (tacrolimus) vs 243 per 1000 | 2 studies · 58 participants | Low Downgraded: risk of bias, imprecision |
Clinical resolution 3-8 weeks | RR 0.86 [0.55, 1.35] 467 per 1000 (tacrolimus) vs 401 per 1000 | 2 studies · 60 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Pain resolution 3-8 weeks | Summary of findings 2: 'No data for this outcome' (triamcinolone vs tacrolimus, pain resolution) | 0 studies | No studies |
Topical triamcinolone acetonide vs Topical ciclosporin
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects end of treatment | RR 0.15 [0.05, 0.49] | 1 study · 139 participants | Ungraded |
Pain (mean VAS score) end of treatment | MD -0.23 [-1.02, 0.56] | 1 study · 139 participants | Ungraded |
Clobetasol propionate ointment vs Triamcinolone acetonide ointment
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical resolution | RR 1.56 [1.09, 2.21] | 2 studies · 57 participants | Low Downgraded: imprecision, inconsistency |
Fluticasone propionate spray vs Betamethasone sodium phosphate mouthrinse
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain / clinical response (not analysable) | Hegarty 2002: cross-over data not suitable for quantitative analysis | 1 study | Ungraded |
Clobetasol propionate 0.025% microspheres vs Clobetasol propionate 0.025% ointment
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical resolution | RR 1.04 [0.80, 1.36] | 1 study · 45 participants | Ungraded |
Pain (mean score) | MD 1.83 [0.80, 2.86] | 1 study · 45 participants | Ungraded |
Clinical score | MD 0.00 [-0.61, 0.61] | 1 study · 45 participants | Ungraded |
Systemic (oral) betamethasone vs Topical triamcinolone acetonide paste
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical score | MD 1.13 [0.09, 2.17] | 1 study · 46 participants | Very low Downgraded: risk of bias, imprecision |
Pain resolution | RR 1.04 [0.60, 1.80] | 1 study · 49 participants | Very low Downgraded: risk of bias, imprecision |
Clobetasol propionate 0.05% ointment vs Clobetasol propionate 0.025% ointment
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical score | MD 0.47 [-0.26, 1.20] | 1 study · 30 participants | Low Downgraded: imprecision |
Clinical resolution | RR 1.14 [0.56, 2.35] | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision |
Pain (mean score) | MD -0.26 [-1.42, 0.90] | 1 study · 30 participants | Low Downgraded: imprecision |
Mucoadhesive prednisolone tablet vs Triamcinolone acetonide paste
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical response (not analysable) | Ghabanchi 2009: data not suitable for quantitative analysis | 1 study | Ungraded |
Dexamethasone plus nystatin (adjunctive antifungal) vs Dexamethasone alone
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical resolution | Wei 2003: no difference in clinical resolution between dexamethasone with vs without nystatin (very low-certainty) | 1 study | Very low Downgraded: risk of bias, imprecision |
Clobetasol propionate plus miconazole (adjunctive antifungal) vs Clobetasol propionate plus placebo
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical score | Lodi 2007: no difference in percentage of oral mucosa affected between adjunctive antifungal and steroid-only groups | 1 study | Ungraded |
Candidosis (adverse effect) | Lodi 2007: 5 cases of candidosis among 15 participants without antifungal vs 0 with adjunctive miconazole (low-certainty) | 1 study · 35 participants | Low Downgraded: imprecision |
Pain (mean score) | Lodi 2007: no benefit of adjunctive miconazole for pain (low to very low certainty collectively) | 1 study | Ungraded |
Oral prednisone plus curcuminoids (adjunctive) vs Oral prednisone plus placebo
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in pain | Chainani-Wu 2007: no difference between adjunctive curcuminoids and placebo (recruitment stopped after interim analysis) | 1 study · 28 participants | Ungraded |
Topical triamcinolone acetonide vs Intralesional BCG-polysaccharide nucleic acid (BCG-PSN)
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score) | MD 0.59 [-0.15, 1.33] | 1 study · 53 participants | Ungraded |
Integrated Chinese and Western medicine (incl. oral prednisone) vs Western medicine (incl. oral prednisone)
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical score | Xu 2002: benefit favouring integrated Chinese and Western medicine, just attained statistical significance (very low-certainty; high risk of bias) | 1 study | Very low Downgraded: risk of bias, imprecision |
Topical betamethasone 0.1% gel vs Topical pimecrolimus 1% gel
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain and clinical response (not analysable) | Ezzatt 2019 (betamethasone 0.1% gel vs pimecrolimus 1% gel): effectiveness data not reported in a way that allowed quantitative analysis | 1 study | Ungraded |
Intralesional betamethasone vs Intralesional triamcinolone acetonide
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical score (14 days) 14 days | MD 9.77 [0.81, 18.73] | 1 study · 59 participants | Very low Downgraded: risk of bias, imprecision |
Clinical resolution | RR 1.40 [1.06, 1.83] | 1 study · 59 participants | Low Downgraded: imprecision |
Pain (mean score) | MD -0.41 [-1.47, 0.65] | 1 study · 59 participants | Low Downgraded: imprecision |
Dexamethasone mouthwash plus nystatin vs Photodynamic therapy
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical resolution | Bakhtiari 2017 (dexamethasone mouthwash + nystatin vs photodynamic therapy): clinical resolution reported (Analysis 4.6); no clear difference (low to very low certainty collectively) | 1 study | Ungraded |
Topical triamcinolone acetonide vs Photodynamic therapy
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical score | MD 1.52 [0.17, 2.87] | 1 study · 20 participants | Low Downgraded: imprecision |
Pain (mean score) | MD 4.9 [2.98, 6.82] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Topical triamcinolone acetonide vs Topical curcumin
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score) | MD -0.64 [-1.19, -0.10] | 2 studies · 100 participants | Low Downgraded: imprecision |
Topical triamcinolone acetonide vs Cryotherapy
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score, split-mouth) | MD 1.48 [0.58, 2.38] | 1 study · 52 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events (split-mouth) | OR 0.01 [0.00, 0.16] | 1 study · 30 participants | Ungraded |
Clobetasol propionate ointment vs Low-level laser therapy (LLLT)
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score) | MD 0.62 [0.42, 0.82] | 1 study · 42 participants | Very low Downgraded: risk of bias, imprecision |
Clinical score | MD 0.56 [0.50, 0.62] | 1 study · 42 participants | Very low Downgraded: risk of bias, imprecision |
Clinical resolution | RR 0.46 [0.22, 0.98] | 1 study · 42 participants | Very low Downgraded: risk of bias, imprecision |
Dexamethasone ointment vs Amlexanox paste
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain resolution | RR 0.75 [0.34, 1.66] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Pain (mean score) | MD 0.05 [-0.78, 0.88] | 1 study · 36 participants | Ungraded |
Topical triamcinolone acetonide vs Hyaluronic acid gel
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score) | MD -0.12 [-0.65, 0.41] | 1 study · 40 participants | Ungraded |
Dexamethasone + nystatin + curcumin (adjunctive) vs Dexamethasone + nystatin + placebo
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score) | Amirchaghmaghi 2016: no benefit of adjunctive curcumin for pain (low to very low certainty collectively) | 1 study | Ungraded |
Adverse effects | Amirchaghmaghi 2016: no adverse effects recorded in either group (low-certainty) | 1 study | Low Downgraded: imprecision |
Clinical resolution | Amirchaghmaghi 2016: no difference in clinical resolution with vs without curcumin (very low-certainty) | 1 study | Very low Downgraded: risk of bias, imprecision |
Triamcinolone plus systemic glucosamine sulphate (adjunctive) vs Triamcinolone alone
Population: People with symptomatic, biopsy-confirmed oral lichen planus (OLP); not concurrently receiving other OLP treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (mean score) | Hesen 2017: no benefit of adjunctive systemic glucosamine sulphate for pain (low to very low certainty collectively) | 1 study | Ungraded |
Clinical score | Hesen 2017: no difference in Thongprasom clinical score with vs without glucosamine sulphate | 1 study | Ungraded |