Efficacy and Safety of Topical Corticosteroids for Management of Oral Chronic Graft versus Host Disease

BACKGROUND: Oral chronic graft versus host disease (cGVHD) is a major complication in transplantation community, a problem that can be addressed with topical intervention. Topical corticosteroids are the first line of treatment although the choice remains challenging as none of the available treatments is supported by strong clinical evidence. OBJECTIVE: This systematic review aims to determine the clinical efficacy and safety of topical corticosteroids for the management of the mucosal alterations of oral cGVHD. DATA SOURCES: Electronic search of different databases was conducted: PubMed, Cochrane library, Grey literature, WHO, and clinical trials.gov for clinical trial registration as well as hand search in the references of relevant articles up to November 2016. DATA EXTRACTION: Extracted pieces of information were intervention, population, sample sizes, and outcomes. DATA SYNTHESIS: Six studies were included: 2 randomized clinical trials (RCTs), 3 cohort studies, and 1 pre-post clinical trial. RESULTS: There is a limited evidence concerning clinical efficacy of topical corticosteroids. Clobetasol, dexamethasone, and budesonide were the topical corticosteroid of choice. The highest level of evidence score was given to clobetasol followed by budesonide with a lower evidence level. CONCLUSION: All three topical corticosteroid preparations are effective for management of oral chronic GVHD with minimal easily avoided side effects.