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Published on: April 23, 2019
Photodynamic therapy for oral candidiasis in human clinical trials: an evidence-based analysis
Yao Lin1, Jianfeng Ding2, Yufu He1
1Jieyang Medical Research Center, Jieyang People's Hospital (Jieyang Affiliated Hospital of Sun Yat-sen University), Jieyang, Guangdong, China.
Objectives:
Traditional antifungal drug treatment (AT) often induce resistance that may limit their ability to eradicate oral candidiasis. This study aimed to evaluate the efficacy of photodynamic therapy (PDT) compared to AT in reducing Candida colony count or improving clinical outcomes in oral candidiasis.
Methods:
We searched relevant articles through Cochrane Library, Web of Science, and PubMed databases up to June 25, 2024. Randomized controlled trials (RCTs) or other clinical comparative studies assessing the effectiveness of single or adjunctive PDT, or conventional chemical therapies were included. Study outcomes were clinical response or the changes from baseline in Candida colony counts.
Results:
A total of 16 clinical trials, including 13 RCTs, were enrolled. The pooled results showed PDT and AT therapy for oral candidiasis have comparable efficacy in the overall response rate (RR=0.97, P = 0.540) and no significant difference in the complete response rate between them. PDT+AT had a higher curing rate than AT alone (RR=1.67, CI: 1.16-2.39, P = 0.005). The network meta‑analysis revealed that PDT+AT, PDT or AT alone improved the reduction of Candida colony counts compared to distilled water treatment. Moreover, PDT+AT was significantly more effective than either PDT or AT alone, and it was most likely to provide the greatest benefit in Candida clearance, followed by AT, PDT, chlorhexidine, and distilled water. There was no statistical difference in the improvement of Candida colony counts between the PDT and AT groups.
Conclusions:
PDT demonstrates comparable efficacy to AT in treating oral candidiasis and may serve as a promising alternative approach. Combining PDT with AT further improves cure rates and Candida reduction. Future large-scale, high-quality RCTs are warranted to confirm these findings.
Insights
Photodynamic therapy (PDT) shows similar effectiveness to antifungal drug treatment (AT) for oral candidiasis. Combining PDT with AT significantly enhances cure rates and reduces Candida counts, offering a promising alternative therapy.
Area of Science:
- Oral medicine
- Antimicrobial therapies
- Photodynamic therapy
Background:
- Traditional antifungal drug treatment (AT) for oral candidiasis can lead to drug resistance.
- Developing alternative and effective treatments for oral candidiasis is crucial.
Purpose of the Study:
- To compare the efficacy of photodynamic therapy (PDT) versus AT in managing oral candidiasis.
- To evaluate the impact of PDT, AT, and their combination on Candida colony counts and clinical outcomes.
Main Methods:
- A systematic review and network meta-analysis of 16 clinical trials, including 13 RCTs, were conducted.
- Searched Cochrane Library, Web of Science, and PubMed databases up to June 25, 2024.
- Outcomes assessed included clinical response and changes in Candida colony counts.
Main Results:
- PDT and AT demonstrated comparable overall response rates for oral candidiasis.
- Combination therapy (PDT+AT) showed a significantly higher cure rate than AT alone.
- PDT+AT was most effective in reducing Candida colony counts, followed by AT, PDT, chlorhexidine, and distilled water.
Conclusions:
- PDT is a viable alternative to AT for oral candidiasis treatment.
- Combining PDT with AT enhances therapeutic outcomes and Candida reduction.
- Further large-scale, high-quality RCTs are recommended to validate these findings.
