A Cochrane review [Abstract] 1 included 35 studies (1474 participants) on glucocorticoid therapies for symptomatic oral lichen planus (OLP).
Glucocorticoids versus placebo. Three studies evaluated the effectiveness and safety of topical corticosteroids in an adhesive base compared to placebo. Two studies were combined in meta-analyses, one evaluating clobetasol propionate and the other flucinonide. Pain may be more likely to be resolved when using a topical corticosteroid rather than a placebo (RR 1.91, 95% CI 1.08 to 3.36; 2 studies, 72 participants). The results for clinical effect of treatment and adverse effects were inconclusive (clinical resolution: RR 6.00, 95% CI 0.76 to 47.58; 2 studies, 72 participants).
Corticosteroids versus calcineurin inhibitors. Three studies compared topical clobetasol propionate versus topical tacrolimus. There was limited evidence regarding any difference between tacrolimus and clobetasol for the outcomes pain resolution (RR 0.45, 95% CI 0.24 to 0.88; 2 studies, 100 participants), clinical resolution (RR 0.61, 95% CI 0.38 to 0.99; 2 studies, 52 participants) and adverse effects (RR 0.05, 95% CI 0.00 to 0.83; 2 studies, 100 participants).One study (39 participants) compared topical clobetasol and ciclosporin. The rate of clinical resolution with clobetasol compared to ciclosporin was RR 3.16, 95% CI 1.00 to 9.93, pain resolution RR 2.11, 95% CI 0.76 to 5.86 and adverse effects RR 6.32, 95% CI 0.84 to 47.69.Two studies (60 participants) that compared triamcinolone and tacrolimus found uncertain evidence regarding the rate of clinical resolution (RR 0.86, 95% CI 0.55 to 1.35) and that there may be a lower rate of adverse effects in the triamcinolone group (RR 0.47, 95% CI 0.22 to 0.99). These studies did not report on pain resolution.
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