Topical medications for the treatment of recurrent aphthous stomatitis: A network meta-analysis.
aphthous ulcer
healing
pain relief
systematic review
topical treatment
Journal
Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology
ISSN: 1600-0714
Titre abrégé: J Oral Pathol Med
Pays: Denmark
ID NLM: 8911934
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
revised:
31
07
2023
received:
21
02
2023
accepted:
03
08
2023
medline:
9
10
2023
pubmed:
27
9
2023
entrez:
27
9
2023
Statut:
ppublish
Résumé
The present network meta-analysis aims to answer the question "what is the best topical intervention for the treatment of recurrent aphthous stomatitis that can provide an acceptable pain relief and promote wound healing?" From inception to October 2022, PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched to identify all potentially eligible randomized controlled trials. The primary outcomes were pain scores and/or healing time, while the secondary outcomes were the associated side effects. The Bayesian network meta-analysis accompanied by a random effect model and 95% credible intervals were calculated. Forty-three randomized controlled trials with a total of 3067 participants, comparing 20 different topical medications, were included. Concerning pain reduction, the network meta-analysis failed to show any statistically significant differences when different topical treatments were compared together or even with a placebo at different time intervals. Except for doxycycline, which showed a statistically significant difference in terms of accelerating healing time, other topical interventions showed no statistically significant differences when compared with placebo or with each other. Within the limitations of the current network meta-analysis, it seems that: A low to moderate quality of evidence showed no superiority of any topical treatment over others concerning pain reduction, although rank probability tests revealed sucralfate, doxycycline, hyaluronic acid, and chamomile as the most efficacious treatment options at different evaluation times. Hence, further well-designed clinical trials with larger sample sizes are warranted. Topical doxycycline was shown to be the most efficacious intervention in promoting healing of recurrent aphthous stomatitis.
Sections du résumé
BACKGROUND
BACKGROUND
The present network meta-analysis aims to answer the question "what is the best topical intervention for the treatment of recurrent aphthous stomatitis that can provide an acceptable pain relief and promote wound healing?"
METHODS
METHODS
From inception to October 2022, PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure were searched to identify all potentially eligible randomized controlled trials. The primary outcomes were pain scores and/or healing time, while the secondary outcomes were the associated side effects. The Bayesian network meta-analysis accompanied by a random effect model and 95% credible intervals were calculated.
RESULTS
RESULTS
Forty-three randomized controlled trials with a total of 3067 participants, comparing 20 different topical medications, were included. Concerning pain reduction, the network meta-analysis failed to show any statistically significant differences when different topical treatments were compared together or even with a placebo at different time intervals. Except for doxycycline, which showed a statistically significant difference in terms of accelerating healing time, other topical interventions showed no statistically significant differences when compared with placebo or with each other.
CONCLUSION
CONCLUSIONS
Within the limitations of the current network meta-analysis, it seems that: A low to moderate quality of evidence showed no superiority of any topical treatment over others concerning pain reduction, although rank probability tests revealed sucralfate, doxycycline, hyaluronic acid, and chamomile as the most efficacious treatment options at different evaluation times. Hence, further well-designed clinical trials with larger sample sizes are warranted. Topical doxycycline was shown to be the most efficacious intervention in promoting healing of recurrent aphthous stomatitis.
Substances chimiques
Doxycycline
N12000U13O
Types de publication
Meta-Analysis
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
811-825Subventions
Organisme : Guangzhou Science and Technology Bureau
ID : 202002030301
Organisme : Guangdong Basic and Applied Research Fund Committee Project
ID : 2021A1515110988
Organisme : Guangdong Health Commission
ID : A2021412
Informations de copyright
© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Tarakji B, Gazal G, Al-Maweri SA, Azzeghaiby SN, Alaizari N. Guideline for the diagnosis and treatment of recurrent aphthous stomatitis for dental practitioners. J Int Oral Health. 2015;7(5):74-80.
Darjani A, Joukar F, Naghipour M, Asgharnezhad M, Mansour-Ghanaei F. Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: the PERSIAN Guilan Cohort Study. Clin Oral Investig. 2021;25(2):711-718. doi:10.1007/s00784-020-03611-y
Saikaly SK, Saikaly TS, Saikaly LE. Recurrent aphthous ulceration: a review of potential causes and novel treatments. J Dermatolog Treat. 2018;29(6):542-552. doi:10.1080/09546634.2017.1422079
Al-Maweri SA, Halboub E, Al-Sharani HM, et al. Association between serum zinc levels and recurrent aphthous stomatitis: a meta-analysis with trial sequential analysis. Clin Oral Investig. 2021;25(2):407-415. doi:10.1007/s00784-020-03704-8
Al-Maweri SA, Alaizari N, Alanazi RH, et al. Efficacy of hyaluronic acid for recurrent aphthous stomatitis: a systematic review of clinical trials. Clin Oral Investig. 2021;25(12):6561-6570. doi:10.1007/s00784-021-04180-4
Altenburg A, El-Haj N, Micheli C, Puttkammer M, Abdel-Naser MB, Zouboulis CC. The treatment of chronic recurrent oral aphthous ulcers. Dtsch Arztebl Int. 2014;111(40):665-673. doi:10.3238/arztebl.2014.0665
Al-Maweri SA, Alaizari N, Alharbi AA, et al. Efficacy of curcumin for recurrent aphthous stomatitis: a systematic review. J Dermatolog Treat. 2020;33(3):1225-1230. doi:10.1080/09546634.2020.1819529
Prathoshini M, Jayanth Kumar V, Ramanathan V. Management of recurrent apthous ulcer using corticosteroids, local anesthetics and nutritional supplements. Bioinformation. 2020;16(12):992-998. doi:10.6026/97320630016992
Al-Maweri SA, Halboub E, Ashraf S, et al. Single application of topical doxycycline in management of recurrent aphthous stomatitis: a systematic review and meta-analysis of the available evidence. BMC Oral Health. 2020;20(1):231. doi:10.1186/s12903-020-01220-5
Lo Muzio L, della Valle A, Mignogna MD, et al. The treatment of oral aphthous ulceration or erosive lichen planus with topical clobetasol propionate in three preparations: a clinical and pilot study on 54 patients. J Oral Pathol Med. 2001;30(10):611-617. doi:10.1034/j.1600-0714.2001.301006.x
Ellepola AN, Samaranayake LP. Inhalational and topical steroids, and oral candidosis: a mini review. Oral Dis. 2001;7(4):211-216.
Beeraka SS, Natarajan K, Patil R, Manne RK, Prathi VS, Kolaparthi VSK. Clinical and radiological assessment of effects of long-term corticosteroid therapy on oral health. Dent Res J. 2013;10(5):666-673.
Buhl R. Local oropharyngeal side effects of inhaled corticosteroids in patients with asthma. Allergy. 2006;61(5):518-526. doi:10.1111/j.1398-9995.2006.01090.x
Cheng B, Zeng X, Liu S, Zou J, Wang Y. The efficacy of probiotics in management of recurrent aphthous stomatitis: a systematic review and meta-analysis. Sci Rep. 2020;10(1):21181. doi:10.1038/s41598-020-78281-7
Alli BY, Erinoso OA, Olawuyi AB. Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a systematic review. J Oral Pathol Med. 2019;48(5):358-364. doi:10.1111/jop.12845
Shavakhi M, Sahebkar A, Shirban F, Bagherniya M. The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: a systematic review of randomized clinical trials. Phytother Res. 2022;36(2):672-685. doi:10.1002/ptr.7332
Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777-784. doi:10.7326/M14-2385
Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, et al., eds. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. John Wiley and Sons; 2019. doi:10.1002/9781119536604.ch8
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926.
Veroniki AA, Straus SE, Fyraridis A, Tricco AC. The rank-heat plot is a novel way to present the results from a network meta-analysis including multiple outcomes. J Clin Epidemiol. 2016;76:193-199. doi:10.1016/j.jclinepi.2016.02.016
van Valkenhoef G, Bujkiewicz S, Efthimiou O, Reid D, Stroomberg C. de Keijser J. gemtc.drugis.org: Bayesian Evidence Synthesis; 2016.
Vijayabala GS, Kalappanavar AN, Annigeri RG, Sudarshan R, Shettar SS. Single application of topical doxycycline hyclate in the management of recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(4):440-446. doi:10.1016/j.oooo.2013.06.015
Uma Maheswari TN, Shanmugasundaram P. Amlexanox in treatment of aphthous ulcers: a systematic review. J Pharm Res. 2013;6(1):214-217. doi:10.1016/j.jopr.2012.11.033
Rouse B, Chaimani A, Li T. Network meta-analysis: an introduction for clinicians. Intern Emerg Med. 2017;12(1):103-111. doi:10.1007/s11739-016-1583-7
Rivera C, Muñoz-Pastén M, Núñez-Muñoz E, Hernández-Olivos R. Recurrent aphthous stomatitis affects quality of life. A case-control study. Clin Cosmet Investig Dent. 2022;14:217-223. doi:10.2147/CCIDE.S369481
Lau CB, Smith GP. Recurrent aphthous stomatitis: a comprehensive review and recommendations on therapeutic options. Dermatol Ther. 2022;35(6):e15500. doi:10.1111/dth.15500
Altenburg A, Abdel-Naser MB, Seeber H, Abdallah M, Zouboulis CC. Practical aspects of management of recurrent aphthous stomatitis. J Eur Acad Dermatol Venereol. 2007;21(8):1019-1026. doi:10.1111/j.1468-3083.2007.02393.x
McHardy GG. A multicenter, double-blind trial of sucralfate and placebo in duodenal ulcer. J Clin Gastroenterol. 1981;3:147-152.
Burch RM, McMillan BA. Sucralfate induces proliferation of dermal fibroblasts and keratinocytes in culture and granulation tissue formation in full-thickness skin wounds. Agents Actions. 1991;34(1-2):229-231. doi:10.1007/BF01993288
Rees WD. Mechanisms of gastroduodenal protection by sucralfate. Am J Med. 1991;91(2A):58S-63S. doi:10.1016/0002-9343(91)90452-4