Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Clin Oral Investig. 2023 Dec;27(12):7091-7114. doi: 10.1007/s00784-023-05357-9. Epub 2023 Nov 3.
The aim of this scoping review was to evaluate the efficacy and safety of the use of systemic nonsteroidal immunomodulators (SNSI) for oral lichen planus (OLP) treatment.
This review was conducted according to PRISMA-ScR guidelines and registered at PROSPERO (CRD42021243524). Consulted databases were Pubmed, Embase, Scopus, and Web of Science. The inclusion criteria was as follows: clinical trials, case series, prospective, and retrospective studies conducted with participants presenting OLP of any sex and age.
Thirty-two studies were selected, assessing 9 different SNSI: methotrexate, dapsone, levamisole, hydroxychloroquine, thalidomide, metronidazole, azathioprine, mycophenolate mofetil, and colchicine. Methotrexate and dapsone were the drugs with the best evidence among the options included, regarding number and quality of studies. Methotrexate resulted in significant improvement in the clinical condition and remission of symptoms, ranging between 63 and 93% of cases. Dapsone presented a similar effect to the use of topical corticosteroids and tacrolimus CONCLUSION: Among SNSI therapeutic options, methotrexate, and dapsone showed promising efficacy and safety. However, large-scale randomized clinical trials are still needed.
SNSI have been used in the treatment of recalcitrant OLP; however, so far, it is not clear which are the best options. This scoping review highlights the potential use of methotrexate and dapsone.
本范围综述旨在评估全身性非甾体类免疫调节剂 (SNSI) 治疗口腔扁平苔藓 (OLP) 的疗效和安全性。
本综述根据 PRISMA-ScR 指南进行，并在 PROSPERO（CRD42021243524）上进行了注册。检索的数据库包括 Pubmed、Embase、Scopus 和 Web of Science。纳入标准如下：对任何性别和年龄的 OLP 患者进行的临床试验、病例系列、前瞻性和回顾性研究。
共选择了 32 项研究，评估了 9 种不同的 SNSI：甲氨蝶呤、氨苯砜、左旋咪唑、羟氯喹、沙利度胺、甲硝唑、硫唑嘌呤、霉酚酸酯和秋水仙碱。甲氨蝶呤和氨苯砜是纳入的药物中证据最好的药物，研究数量和质量都较高。甲氨蝶呤可显著改善临床状况和缓解症状，63%至 93%的病例有效。氨苯砜的疗效与局部皮质类固醇和他克莫司相似。
在 SNSI 治疗选择中，甲氨蝶呤和氨苯砜显示出有希望的疗效和安全性。然而，仍需要大规模的随机临床试验。
SNSI 已用于治疗难治性 OLP；然而，到目前为止，还不清楚哪种药物是最好的选择。本范围综述强调了甲氨蝶呤和氨苯砜的潜在用途。
