Management of oral Graft versus Host Disease with topical agents: A systematic review

R Albuquerque; Z Khan; A Poveda; J Higham; A Richards; L Monteiro; E Jané-Salas; J Lopez-Lopez; S Warnakulasuriya

doi:10.4317/medoral.20968

Management of oral Graft versus Host Disease with topical agents: A systematic review

R Albuquerque, Z Khan, A Poveda, J Higham, A Richards, L Monteiro, E Jané-Salas, J Lopez-Lopez, S Warnakulasuriya

Dentistry

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

BACKGROUND: Oral Graft-versus-Host Disease (oGvHD) is a common complication of haematopoietic stem cell transplantation. Choosing the right topical application to be used intra orally can be a challenge. Consequently, the aim of this work is to review the effectiveness and safety of topical agents currently used in the management of the inflammatory mucosal lesions encountered in oGVHD.

MATERIAL AND METHODS: We carried out electronic searches of publications up to May 2015 of the databases Pubmed, National Library of Medicine's Medline, Embase and the Cochrane Central Register of Controlled Clinical trials to identify potentially relevant studies (keywords: "oral", "graft", "versus", "host", "disease" and "treatment"). The main inclusion criterion was the reported use of a topical agent which was not intentionally swallowed when used for the treatment of oGVHD. A 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care and the Centre for Reviews and Dissemination, University of York, was used to rate the methodological quality of the papers.

RESULTS: From the 902 entries identified in the search, 7 studies qualifying for inclusion were analysed. Overall, there is limited evidence with regards to the effectiveness of topical steroids for oGVHD. However, the studies showed some effect of Budesonide alone and when combined with dexamethasone. Topical tacrolimus also appears to have some effect and clobetasol propionate mouthwash had a significantly better clinical response than dexamethasone mouthwash in treating oGVHD.

CONCLUSIONS: As the number of clinical trials conducted is limited, there is little evidence to support the use of topical therapies to treat the inflammatory mucosal lesions found in oGVHD. High quality randomised control trials are needed in order to measure the effectiveness of any topical application for the treatment of the inflammatory mucosal lesions found in oGVHD.

Original language	English
Pages (from-to)	72-81
Journal	Medicina Oral, Patologia Oral y Cirugia Bucal
Volume	21
DOIs	https://doi.org/10.4317/medoral.20968
Publication status	Published - 30 Nov 2015

ASJC Scopus subject areas

Dentistry(all)
Pharmacology, Toxicology and Pharmaceutics(all)
Medicine(all)

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10.4317/medoral.20968

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title = "Management of oral Graft versus Host Disease with topical agents: A systematic review",

abstract = "BACKGROUND: Oral Graft-versus-Host Disease (oGvHD) is a common complication of haematopoietic stem cell transplantation. Choosing the right topical application to be used intra orally can be a challenge. Consequently, the aim of this work is to review the effectiveness and safety of topical agents currently used in the management of the inflammatory mucosal lesions encountered in oGVHD.MATERIAL AND METHODS: We carried out electronic searches of publications up to May 2015 of the databases Pubmed, National Library of Medicine's Medline, Embase and the Cochrane Central Register of Controlled Clinical trials to identify potentially relevant studies (keywords: {"}oral{"}, {"}graft{"}, {"}versus{"}, {"}host{"}, {"}disease{"} and {"}treatment{"}). The main inclusion criterion was the reported use of a topical agent which was not intentionally swallowed when used for the treatment of oGVHD. A 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care and the Centre for Reviews and Dissemination, University of York, was used to rate the methodological quality of the papers.RESULTS: From the 902 entries identified in the search, 7 studies qualifying for inclusion were analysed. Overall, there is limited evidence with regards to the effectiveness of topical steroids for oGVHD. However, the studies showed some effect of Budesonide alone and when combined with dexamethasone. Topical tacrolimus also appears to have some effect and clobetasol propionate mouthwash had a significantly better clinical response than dexamethasone mouthwash in treating oGVHD.CONCLUSIONS: As the number of clinical trials conducted is limited, there is little evidence to support the use of topical therapies to treat the inflammatory mucosal lesions found in oGVHD. High quality randomised control trials are needed in order to measure the effectiveness of any topical application for the treatment of the inflammatory mucosal lesions found in oGVHD.",

author = "R Albuquerque and Z Khan and A Poveda and J Higham and A Richards and L Monteiro and E Jan{\'e}-Salas and J Lopez-Lopez and S Warnakulasuriya",

year = "2015",

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day = "30",

doi = "10.4317/medoral.20968",

language = "English",

volume = "21",

pages = "72--81",

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T1 - Management of oral Graft versus Host Disease with topical agents

T2 - A systematic review

AU - Albuquerque, R

AU - Khan, Z

AU - Poveda, A

AU - Higham, J

AU - Richards, A

AU - Monteiro, L

AU - Jané-Salas, E

AU - Lopez-Lopez, J

AU - Warnakulasuriya, S

PY - 2015/11/30

Y1 - 2015/11/30

N2 - BACKGROUND: Oral Graft-versus-Host Disease (oGvHD) is a common complication of haematopoietic stem cell transplantation. Choosing the right topical application to be used intra orally can be a challenge. Consequently, the aim of this work is to review the effectiveness and safety of topical agents currently used in the management of the inflammatory mucosal lesions encountered in oGVHD.MATERIAL AND METHODS: We carried out electronic searches of publications up to May 2015 of the databases Pubmed, National Library of Medicine's Medline, Embase and the Cochrane Central Register of Controlled Clinical trials to identify potentially relevant studies (keywords: "oral", "graft", "versus", "host", "disease" and "treatment"). The main inclusion criterion was the reported use of a topical agent which was not intentionally swallowed when used for the treatment of oGVHD. A 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care and the Centre for Reviews and Dissemination, University of York, was used to rate the methodological quality of the papers.RESULTS: From the 902 entries identified in the search, 7 studies qualifying for inclusion were analysed. Overall, there is limited evidence with regards to the effectiveness of topical steroids for oGVHD. However, the studies showed some effect of Budesonide alone and when combined with dexamethasone. Topical tacrolimus also appears to have some effect and clobetasol propionate mouthwash had a significantly better clinical response than dexamethasone mouthwash in treating oGVHD.CONCLUSIONS: As the number of clinical trials conducted is limited, there is little evidence to support the use of topical therapies to treat the inflammatory mucosal lesions found in oGVHD. High quality randomised control trials are needed in order to measure the effectiveness of any topical application for the treatment of the inflammatory mucosal lesions found in oGVHD.

AB - BACKGROUND: Oral Graft-versus-Host Disease (oGvHD) is a common complication of haematopoietic stem cell transplantation. Choosing the right topical application to be used intra orally can be a challenge. Consequently, the aim of this work is to review the effectiveness and safety of topical agents currently used in the management of the inflammatory mucosal lesions encountered in oGVHD.MATERIAL AND METHODS: We carried out electronic searches of publications up to May 2015 of the databases Pubmed, National Library of Medicine's Medline, Embase and the Cochrane Central Register of Controlled Clinical trials to identify potentially relevant studies (keywords: "oral", "graft", "versus", "host", "disease" and "treatment"). The main inclusion criterion was the reported use of a topical agent which was not intentionally swallowed when used for the treatment of oGVHD. A 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care and the Centre for Reviews and Dissemination, University of York, was used to rate the methodological quality of the papers.RESULTS: From the 902 entries identified in the search, 7 studies qualifying for inclusion were analysed. Overall, there is limited evidence with regards to the effectiveness of topical steroids for oGVHD. However, the studies showed some effect of Budesonide alone and when combined with dexamethasone. Topical tacrolimus also appears to have some effect and clobetasol propionate mouthwash had a significantly better clinical response than dexamethasone mouthwash in treating oGVHD.CONCLUSIONS: As the number of clinical trials conducted is limited, there is little evidence to support the use of topical therapies to treat the inflammatory mucosal lesions found in oGVHD. High quality randomised control trials are needed in order to measure the effectiveness of any topical application for the treatment of the inflammatory mucosal lesions found in oGVHD.

UR - http://www.ncbi.nlm.nih.gov/pubmed/26615510

U2 - 10.4317/medoral.20968

DO - 10.4317/medoral.20968

M3 - Article

C2 - 26615510

SN - 1698-4447

VL - 21

SP - 72

EP - 81

JO - Medicina Oral, Patologia Oral y Cirugia Bucal

JF - Medicina Oral, Patologia Oral y Cirugia Bucal

ER -

Management of oral Graft versus Host Disease with topical agents: A systematic review

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