Systemic non-steroidal immunomodulators for oral lichen planus treatment—a scoping review

• Published in: Clinical oral investigations Vol. 27; no. 12; pp. 7091 - 7114
• Main Authors: Pedraça, Erick Souza, da Silva, Eduardo Liberato, de Lima, Taiane Berguemaier, Rados, Pantelis Varvaki, Visioli, Fernanda
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2023; Springer Nature B.V
• Subjects: Azathioprine; Clinical trials; Colchicine; Corticosteroids; Dapsone; Dentistry; Hydroxychloroquine; Immunomodulation; Immunomodulators; Levamisole; Lichen planus; Medicine; Methotrexate; Metronidazole; Mycophenolate mofetil; Mycophenolic acid; Remission; Review; Tacrolimus; Thalidomide; Oral; Review; Lichen planus; Drug therapy; Immunomodulation; Therapeutics
• ISSN: 1436-3771; 1432-6981; 1436-3771
• DOI: 10.1007/s00784-023-05357-9

Objective 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. Materials and methods 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. Results 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. Clinical relevance 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.