Oral lichen planus: comparative efficacy and treatment costs-a systematic review.
Shaiba Sandhu, Brittany A Klein, Malak Al-Hadlaq, Prazwala Chirravur, Amal Bajonaid, Yuanming Xu, Rossella Intini, Mai Hussein, Piamkamon Vacharotayangul, Herve Sroussi, Nathaniel Treister, Stephen Sonis
Author Information
Shaiba Sandhu: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA. ssandhu@mgh.harvard.edu.
Brittany A Klein: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Malak Al-Hadlaq: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Prazwala Chirravur: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Amal Bajonaid: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Yuanming Xu: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Rossella Intini: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Mai Hussein: Harvard Medical School, Boston, MA, USA.
Piamkamon Vacharotayangul: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Herve Sroussi: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Nathaniel Treister: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
Stephen Sonis: Division of Oral Medicine and Dentistry, Brigham and Women's Hospital/ Dana Farber Cancer Institute, Boston, USA.
OBJECTIVE: To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). MATERIALS AND METHODS: A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. RESULTS: Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. CONCLUSION: Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.
