Zhang Yuanmei, Mao Chenhao, Zhu Juanfang, Yang Wenli, Wang Yanli, Yu Weiwei, Wang Jing, Li Na, Guo Jia, Zhang Qi, Zhou Yi, Peng Mengdong, Wang Yining
Department of Prosthodontics, the First Affiliated Hospital of Zhengzhou University, 1# East Road, Zhengzhou, China.
Henan University of Economics and Law, School of Business Administration, Zhengzhou, China.
BMC Oral Health. 2025 Jul 1;25(1):962. doi: 10.1186/s12903-025-06120-0.
The evaluation of short-term pain relief provided by newly developed drugs for the treatment of oral lichen planus is currently limited. The primary aim of this study was to establish a clinically relevant hierarchy among different treatments in terms of their effectiveness for short-term pain control.
EMBASE, Scopus, PubMed, WanFang database, and Cochrane databases were searched up to January 2025. A Bayesian network meta-analysis (NMA) was conducted using Stata/SE 15.1 software. The primary outcome was the reduction in pain severity, and the secondary outcome was the improvement in clinical sign scores. The Cochrane Risk of Bias Tool was used to assess the risk of bias, and confidence in network meta-analysis(CINeMA) was employed to evaluate the confidence in evidence. NMA was performed in Stata within a frequentist framework, and heterogeneity and inconsistency were assessed. Heterogeneity, inconsistency, and sensitivity were analyzed, with comprehensive efficacy rankings derived from surface under the cumulative ranking curve (SUCRA) values.
Sixty-four randomized trials (2,839 participants) evaluating 24 interventions were included. Corticosteroids and immunosuppressants demonstrated significant efficacy in pain control and sign score improvement. Topical laser therapy and plant-based agents (e.g. Chamomile) emerged as effective alternatives, particularly for early-to-mid stage symptom management.
Based on the evidence, highly effective topical corticosteroids are preferred, and immunosuppressants can be used when corticosteroids are ineffective or cause adverse effects, both in terms of pain control and sign score reduction. Phototherapy and botanicals offer favorable safety profiles for sustained use. Future research should focus on exploring more effective administration methods and combination therapies with fewer side effects.
This NMA provides a time-dependent therapeutic hierarchy for oral lichen planus management, addressing gaps in comparative effectiveness evidence. While limitations exist in long-term outcome data, findings support personalized treatment sequences based on symptom severity and treatment phase.
The systematic review protocol has been registered in advance with the PROSPERO database (CRD42020197486).
目前，对于新开发的用于治疗口腔扁平苔藓的药物所提供的短期疼痛缓解效果的评估有限。本研究的主要目的是根据不同治疗方法在短期疼痛控制方面的有效性，建立一个具有临床相关性的等级体系。
检索截至2025年1月的EMBASE、Scopus、PubMed、万方数据库和Cochrane数据库。使用Stata/SE 15.1软件进行贝叶斯网络荟萃分析（NMA）。主要结局是疼痛严重程度的降低，次要结局是临床体征评分的改善。使用Cochrane偏倚风险工具评估偏倚风险，并采用网络荟萃分析置信度（CINeMA）评估证据的置信度。在频率主义框架内，在Stata中进行NMA，并评估异质性和不一致性。分析异质性、不一致性和敏感性，并根据累积排序曲线下面积（SUCRA）值得出综合疗效排名。
纳入了64项评估24种干预措施的随机试验（2839名参与者）。皮质类固醇和免疫抑制剂在疼痛控制和体征评分改善方面显示出显著疗效。局部激光治疗和植物性药物（如洋甘菊）是有效的替代方法，尤其适用于中早期症状管理。
基于现有证据，在疼痛控制和体征评分降低方面，高效的局部皮质类固醇是首选，当皮质类固醇无效或引起不良反应时，可使用免疫抑制剂。光疗和植物药具有良好的安全性，可长期使用。未来的研究应侧重于探索更有效的给药方法和副作用更少的联合治疗。
本NMA为口腔扁平苔藓的管理提供了一个基于时间的治疗等级体系，填补了比较有效性证据方面的空白。虽然长期结局数据存在局限性，但研究结果支持根据症状严重程度和治疗阶段进行个性化治疗顺序。
系统评价方案已预先在PROSPERO数据库注册（CRD42020197486）。
