Pediatric Hematology/Oncology, Herman & Walter Samuelson Children's Hospital at Sinai, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
Johns Hopkins School of Nursing, Baltimore, MD, USA.
Support Care Cancer. 2022 Sep;30(9):7205-7218. doi: 10.1007/s00520-022-07068-5. Epub 2022 Apr 29.
Mucositis is severely painful and often reported as one of the most distressing adverse effects of cancer therapy; it is a significant threat to quality of life as well as life itself. Anti-inflammatory agents may modulate physiologic mechanisms that perpetuate mucositis and be useful in prevention efforts. Because systemic anti-inflammatory agents are not appropriate for many patients, locally acting agents (mouthwashes) may be more feasible for use. This review and meta-analysis evaluates the role that anti-inflammatory mouthwashes have in preventing or reducing oral mucositis associated with chemotherapy and radiation therapy.
A systematic literature review was conducted to identify studies evaluating the efficacy of anti-inflammatory mouthwashes to prevent therapy-associated mucositis. Meta-analysis was conducted to determine efficacy in preventing any mucositis and dose-limiting mucositis.
Eight peer-reviewed publications were identified; corticosteroid and nonsteroidal anti-inflammatory mouthwashes are effective in reducing overall incidence of mucositis and are associated with lower severity of mucositis. Meta-analysis reveals significant reduction in symptomatic mucositis incidence (OR 6.00, 95% CI 4.39-8.20, p < 0.0001) and reduction of dose-limiting mucositis (OR 2.12, 95% CI 1.07-4.28, p = 0.032).
Mouthwashes containing anti-inflammatory agents are a potential effective means to prevent or reduce mucositis associated with cancer therapy. There are limited adverse effects from these agents, and adherence is high, indicating safety and feasibility of use. Anti-inflammatory mouthwashes should be considered for supportive care in persons at risk for mucositis and must be further evaluated to investigate efficacy across multiple chemotherapy agents, adverse effects, and impacts on symptoms, pain, and quality of life.
黏膜炎是一种严重的疼痛，常被报告为癌症治疗中最令人痛苦的不良反应之一；它严重威胁着生活质量，甚至生命本身。抗炎剂可能调节持续发生黏膜炎的生理机制，因此在预防方面可能有用。由于全身性抗炎剂不适合许多患者，局部作用的制剂（漱口液）可能更适合使用。本综述和荟萃分析评估了抗炎漱口液在预防或减轻与化疗和放疗相关的口腔黏膜炎中的作用。
进行了系统的文献综述，以确定评估抗炎漱口液预防治疗相关黏膜炎的疗效的研究。进行荟萃分析以确定预防任何黏膜炎和剂量限制黏膜炎的疗效。
确定了 8 篇同行评议的出版物；皮质类固醇和非甾体抗炎漱口液可有效降低黏膜炎总发生率，并与较低的黏膜炎严重程度相关。荟萃分析显示，症状性黏膜炎发生率显著降低（OR 6.00，95%CI 4.39-8.20，p<0.0001），剂量限制黏膜炎减少（OR 2.12，95%CI 1.07-4.28，p=0.032）。
含有抗炎剂的漱口液是预防或减轻癌症治疗相关黏膜炎的潜在有效手段。这些制剂的不良反应有限，且患者的依从性高，表明使用的安全性和可行性。抗炎漱口液应考虑用于有黏膜炎风险的患者的支持性护理，必须进一步评估以调查其在多种化疗药物、不良反应以及对症状、疼痛和生活质量的影响方面的疗效。
