Evaluating calcineurin inhibitors as alternatives to steroids in treating Oral Lichen Planus: a systematic review and meta-analysis

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Introduction: Oral Lichen Planus is a chronic inflammatory disease and a potentially malignant disorder of the oral mucosa. We aimed to investigate the possibility of replacing the gold-standard steroids (ST) due to their propensity for drug tolerance and numerous associated side effects. Recently, calcineurin inhibitors (CNI) have emerged as a promising alternative to ST. The main objective of the recent study was to compare the therapeutic effects of CNI and ST on OLP through pain severity, lesion morphology, and adverse effects. Materials and methods: A systematic search was conducted in 4 databases (Pubmed, Embase, Central, and Web of Science) on November 26th, 2023. Randomized controlled trials (RCTs) were selected for the analysis, which compared topically used CNIs, STs, or placebo. The outcomes were pain severity, oral mucosa morphology, and safety (adverse effects, especially transient burning). Odds ratios (ORs) and mean differences (MDs) with the random-effects model were calculated in the quantitative synthesis and interpreted with 95% confidence intervals (CIs). Results: A total of eleven RCTs were selected for quantitative analysis. Topically applied ST tended to decrease pain after four weeks of treatment (MD: -0.06, 95%CI: -0.55; 0.44) and promoted healing better (MD: -0.08, 95%CI: -0.74; 0.57) than measured in CNI therapy. Transient burning occurred more often in the CNI group (OR: 2.45, 95%CI: 0.55; 10.85). Discussion: Topical STs and topically used CNIs have a similar effect. However, data show a higher rate of side effects with CNI, particularly transient burning during the first two days of treatment. Clinical relevance: Topical STs and topically used CNIs have a similar effect. However, data show a higher rate of side effects with CNI, particularly transient burning during the first two days of treatment. Topically applied STs may remain the gold standard for symptomatic OLP. The evidence is currently insufficient to support replacing ST with CNI in OLP treatment in routine clinical practice. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023486435, PROSPERO CRD42023486435.

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