Haas Livia, Cruz-Pamplona Marta
Degree in Dentistry. Faculty of Health Sciences. Universidad Europea de Valencia. Spain.
Degree in Dentistry. Master in Oral Medicine and Surgery. Faculty of Medicine and Dentistry. University of Valencia. Spain.
J Clin Exp Dent. 2023 May 1;15(5):e420-e427. doi: 10.4317/jced.60138. eCollection 2023 May.
Oral graft-versus-host disease (GVHD) is a common complication of hematopoietic stem cell transplantation. This study systematically reviewed Randomized Controlled Trials (RCTs) with the objective to investigate the effectiveness and side effects of topical agents used for the treatment of oral GVHD.
The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed to perform this study. An electronic search of four databases was conducted. RCTs published between January 2011 and March 2022 were included that were carried out on hematopoietic stem cell transplant recipients receiving topical treatment for oral GVHD. The Critical Appraisal Skills Program (CASP) standard checklist for RCTs was used for the bias risk evaluation.
Five RCTs were included for the qualitative synthesis of results. Two RCTs were linked to a certain risk of bias. Budesonide caused the highest overall treatment response. Malic acid, clobetasol, and dexamethasone increased resting salivary flow rates. Curcumin in orabase shows similar results to corticosteroid treatment. Adverse effects were observed in populations receiving budesonide, dexamethasone, clobetasol, and tacrolimus. Most frequent adverse effects were burning sensations, fungal infections, and gastrointestinal disorders, but none of them were severe.
Given the small number of RCTs performed and the heterogeneity of the different study designs, it is difficult to draw direct comparisons. Malic acid appears to be effective for the treatment of graft-versus-host disease-induced xerostomia. Budesonide had the highest overall response rates but was also associated with the highest number of adverse effects. Further research is needed to manifest those findings. Hematopoietic stem cell transplant, oral graft-versus-host disease, topical treatment.
口腔移植物抗宿主病（GVHD）是造血干细胞移植的常见并发症。本研究系统回顾了随机对照试验（RCT），旨在调查用于治疗口腔GVHD的局部用药的有效性和副作用。
本研究遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。对四个数据库进行了电子检索。纳入2011年1月至2022年3月发表的、针对接受口腔GVHD局部治疗的造血干细胞移植受者开展的RCT。采用RCT的关键评估技能计划（CASP）标准清单进行偏倚风险评估。
纳入五项RCT进行结果的定性综合分析。两项RCT存在一定偏倚风险。布地奈德的总体治疗反应最高。苹果酸、氯倍他索和地塞米松可提高静息唾液流速。含药糊剂中的姜黄素显示出与皮质类固醇治疗相似的结果。在接受布地奈德、地塞米松、氯倍他索和他克莫司治疗的人群中观察到了不良反应。最常见的不良反应为烧灼感、真菌感染和胃肠道疾病，但均不严重。
鉴于开展的RCT数量较少且不同研究设计存在异质性，难以进行直接比较。苹果酸似乎对治疗移植物抗宿主病引起的口干有效。布地奈德的总体反应率最高，但不良反应数量也最多。需要进一步研究来证实这些发现。造血干细胞移植、口腔移植物抗宿主病、局部治疗。
