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Comparative effectiveness of medicinal interventions for oral submucous fibrosis: A network meta-analysis
Arpita Rai1, Priyanshu Kumar Shrivastava2, Ansul Kumar3
1Oral Medicine and Radiology, Dental College, Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi 834009, India.
Objectives:
This network meta-analysis presents an exhaustive description and comparison of the available medical interventions for the management of oral submucous fibrosis (OSMF).
Materials And Methods:
A systematic review and network meta-analysis was conducted after registration with PROSPERO. (PROSPERO ID CRD42022303441). Databases (PubMed, Cochrane, EMBASE, Web of Science, and others) were searched for randomized clinical trials (RCT) trials from inception till September 2022 for the medical interventions in OSMF. The primary outcome was the improvement in mouth opening. The secondary outcomes were improvement in burning sensation, tongue protrusion, and cheek flexibility. The interventions were ranked according to their efficacy based on the surface under the cumulative ranking.
Results:
47 studies including 2393 patients were assessed for quantitative analysis. For mouth opening, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective [MD, 7.05 (95%CI 1.76,12.34)], followed by the combination of oral antioxidants with injectable steroids, [MD, 3.80 (95%CI -0.44,8.03)]. Additionally, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective in reducing the burning sensation [MD, -8.62(-10.95,-6.30)], followed by aloe vera [MD, -8.45(-10.40,-6.49)] and pentoxifylline [MD -7.57(-9.46,-5.68)]. For tongue protrusion, curcumin was most effective followed by antioxidants. Most of the drugs used were reported to cause negligible or mild adverse effects.
Conclusion:
This network meta-analysis reported the efficacy of medicinal interventions in OSMF patients compared to the placebo in the improvement of mouth opening and burning sensation, and cheek flexibility. The methodological quality of included RCTs was low. Well-designed studies are recommended to obtain strong evidence.
Insights
The most effective medical treatment for oral submucous fibrosis (OSMF) involves a combination of steroids, hyaluronidase, and antioxidants, significantly improving mouth opening and reducing burning sensations. Further high-quality research is recommended.
Area of Science:
- Oral Medicine
- Pharmacology
- Evidence-Based Dentistry
Background:
- Oral submucous fibrosis (OSMF) is a chronic, potentially malignant disorder characterized by reduced mouth opening and burning sensations.
- Current medical management strategies for OSMF lack comprehensive comparative efficacy data.
- This study addresses the need for evidence-based recommendations on medical interventions for OSMF.
Approach:
- A systematic review and network meta-analysis of randomized clinical trials (RCTs) were conducted.
- Searched multiple databases (PubMed, Cochrane, EMBASE, Web of Science) for RCTs on OSMF medical interventions up to September 2022.
- Analyzed 47 studies involving 2393 patients, focusing on mouth opening, burning sensation, tongue protrusion, and cheek flexibility.
Key Points:
- Combined therapy with steroid, hyaluronidase, and antioxidant demonstrated the greatest improvement in mouth opening (MD, 7.05).
- This combination also proved most effective in reducing burning sensations (MD, -8.62), followed by aloe vera and pentoxifylline.
- Curcumin and antioxidants showed efficacy in improving tongue protrusion, with most interventions reporting mild adverse effects.
Conclusions:
- The network meta-analysis provides a comparative efficacy of medical interventions for OSMF.
- Combined steroid, hyaluronidase, and antioxidant therapy is the most effective medical intervention for improving mouth opening and reducing burning sensation in OSMF patients.
- The low methodological quality of included RCTs highlights the need for well-designed studies to establish robust evidence.
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