Efficacy and safety of hydroxychloroquine or chloroquine for oral lichen planus:a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Mimi ¹ , HU Lijun ¹ , CHEN Qianming ² ,  HUA Hong ¹

1. Department of Oral Medicine, Peking University School and Hospital of Stomatology; National Clinical Research Center for Oral Diseases; National Engineering Laboratory for Digital and Material Technology of Stomatology; Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, P.R.China;
2. State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

HUA Hong, Email: honghua1968@aliyun.com

Keywords：

Oral lichen planus; Hydroxychloroquine; Chloroquine; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201809118

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the efficacy and safety of hydroxychloroquine (HCQ) and chloroquine (CQ) for oral lichen planus (OLP).Methods PubMed, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of HCQ and CQ for OLP from inception to September, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 10 RCTs involving 726 patients were included. The results of meta-analysis showed that: HCQ or CQ were more effective than placebos (P<0.05). Nevertheless, they were inferior to oral traditional Chinese medicine (RR=0.75, 95%CI 0.69 to 0.82, P<0.000 01). In addition, the ratio of CD4⁺/CD8⁺ T cell increased significantly in peripheral blood of OLP patients after treatment with HCQ or CQ (MD=–0.28, 95%CI –0.44 to –0.13, P=0.000 3). The incidences of adverse reaction of HCQ or CQ were higher than orally traditional Chinese medicine (RR=11.80, 95%CI 4.85 to 28.68, P<0.000 01), and the difference was statistically significant.Conclusions Current evidence shows that the efficacy of HCQ or CQ for OLP were significantly superior to placebo, while inferior to orally traditional Chinese medicine. The possible therapeutic mechanism of HCQ or CQ for OLP may be related to the regulation of the ratio of CD4⁺/CD8⁺ T cells and cellular immunity of OLP patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

Citation： ZHOU Mimi, HU Lijun, CHEN Qianming, HUA Hong. Efficacy and safety of hydroxychloroquine or chloroquine for oral lichen planus:a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(4): 430-438. doi: 10.7507/1672-2531.201809118 Copy

1.	Warnakulasuriya S, Johnson NW, Vand WI. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med, 2007, 36(10): 575.
2.	Alaizari NA, Almaweri SA, Alshamiri HM, et al. Hepatitis c virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J, 2015, 61(3): 282-287.
3.	Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, Part I: Facts and controversies. Clin Dermatol, 2010, 28(1): 100.
4.	Saini R, Al-Maweri SA, Saini D, et al. Oral mucosal lesions in non-oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions. Diabetes Res Clin Pr, 2010, 89(3): 320-326.
5.	中华口腔医学会口腔黏膜病专业委员会, 中华口腔医学会中西医结合专业委员会, 周红梅. 口腔扁平苔藓诊疗指南(试行). 中华口腔医学杂志, 2012, 47(7): 399-401.
6.	余春晓, 李杏, 孙尔维. 羟氯喹抗风湿病的辛路历程. 中华风湿病学杂志, 2018, 22(1): 35-37.
7.	Rainsford KD, Parke AL, Clifford-Rashotte M, et al. Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases. Inflammopharmacology, 2015, 23(5): 1-39.
8.	Ruizirastorza G, Ramoscasals M, Britozeron P, et al. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis, 2010, 69(1): 20.
9.	Suarezalmazor ME, Belseck E, Shea B, et al. Antimalarials for rheumatoid arthritis. Coch Data Sys Rev, 2001, (2): CD000959.
10.	Mostafa WZ. Lichen planus of the nail: treatment with antimalarial. J Am Acad Dermatol, 1989, 20(2 Pt 1): 289.
11.	Eisen D. Hydroxychloroquine sulfate (Plaquenil) improves oral lichen planus: An open trial. J Am Acad Dermatol, 1993, 28(4): 609-612.
12.	Rivastolosa N, Requena C, Llombart B, et al. Antimalarial drugs for the treatment of oral erosive lichen planus. Dermatology, 2015, 232(1): 86-90.
13.	曹宏康, 张水龙, 徐维宁, 等. 口服氯化喹啉与局注确炎舒松-A 治疗口腔扁平苔藓. 上海口腔医学, 1996, 5(3): 140-142.
14.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Revista Española De Nutrición Humana Y Dietética, 2009, 18(3): e123.
15.	朱聘倬. 清热解毒养阴中药治疗口腔扁平苔藓 62 例-附西药对照组 30 例. 辽宁中医杂志, 2001, 28(12): 728-729.
16.	金早蓉, 秦念红, 陈燕丹, 等. 复方甘草酸苷治疗口腔扁平苔藓的临床疗效观察及免疫机制研究. 齐齐哈尔医学院学报, 2013, 34(9): 1276-1277.
17.	黄晓慧. 苔藓方治疗糜烂型口腔扁平苔藓的临床疗效观察. 郑州: 河南中医药大学, 2009.
18.	王北溟. 益气活血祛湿法治疗口腔扁平苔藓(气虚血瘀湿浊型)的临床研究. 郑州: 河南中医学院, 2006.
19.	李俊荣, 侯文勇, 宫卫星, 等. 复方消苔颗粒治疗口腔扁平苔藓临床观察. 中医药临床杂志, 2012, 24(5): 427-429.
20.	徐帆. 辨证治疗糜烂型口腔扁平苔藓 42 例临床观察. 新中医, 2015, (9): 68-70.
21.	王艳. 加味苔藓饮治疗口腔扁平苔藓疗效观察. 浙江中西医结合杂志, 2010, 20(10): 632.
22.	杨淑琴, 蔡剑, 杨晓霞. 活血化瘀方治疗口腔糜烂型扁平苔藓的临床观察. 口腔医学, 2014, 34(4): 288-290.
23.	Bendas ER, Abdullah H, El-Komy MH, et al. Hydroxychloroquine niosomes: a new trend in topical management of oral lichen planus. Int J Pharmaceut, 2013, 458(2): 287.
24.	徐治鸿. 中西医结合口腔黏膜病学(精). 北京: 人民卫生出版社, 2008.
25.	Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Brit J Oral Max Surg, 2008, 46(1): 15-21.
26.	Crincoli V, Bisceglie MBD, Scivetti M, et al. Oral lichen planus: update on etiopathogenesis, diagnosis and treatment. Immunopharmacol Immunotoxicol, 2011, 33(1): 11.
27.	谢勋, 许国祺. 氯化喹啉在口腔粘膜病中的应用. 口腔医学, 1985, (3): 155-156.
28.	魏太星, 魏经汉. 医生专用药物手册. 郑州: 河南科学技术出版社, 2015.
29.	刘翠萍, 陆春燕, 王文梅. 磷酸氯喹在口腔扁平苔藓中的临床应用. 临床口腔医学杂志, 2003, 19(10): 633-635.
30.	王才惠, 段西凌. 羟氯喹在治疗皮肤病中的应用. 临床皮肤科杂志, 2013, 42(4): 259-261.
31.	赖红昌, 曹宏康, 乐福媛. 口腔扁平苔藓患者 T 细胞亚群、sIL-2R 水平的动态观察. 实用口腔医学杂志, 1997, (4): 9-11, 65.
32.	邓冠红, 陈作良, 陈宏柏, 等. T 细胞免疫和细胞凋亡在口腔扁平苔藓发病中的作用. 华西口腔医学杂志, 2009, 27(3): 256-259.
33.	刘雅菁, 王文梅. 口腔扁平苔藓中 T 淋巴细胞亚群的研究进展. 国际口腔医学杂志, 2011, 38(4): 433-435.
34.	华红, 刘宏伟. 口腔黏膜学. 北京: 北京大学医学出版社, 2014.

1. Warnakulasuriya S, Johnson NW, Vand WI. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med, 2007, 36(10): 575.
2. Alaizari NA, Almaweri SA, Alshamiri HM, et al. Hepatitis c virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J, 2015, 61(3): 282-287.
3. Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, Part I: Facts and controversies. Clin Dermatol, 2010, 28(1): 100.
4. Saini R, Al-Maweri SA, Saini D, et al. Oral mucosal lesions in non-oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions. Diabetes Res Clin Pr, 2010, 89(3): 320-326.
5. 中华口腔医学会口腔黏膜病专业委员会, 中华口腔医学会中西医结合专业委员会, 周红梅. 口腔扁平苔藓诊疗指南(试行). 中华口腔医学杂志, 2012, 47(7): 399-401.
6. 余春晓, 李杏, 孙尔维. 羟氯喹抗风湿病的辛路历程. 中华风湿病学杂志, 2018, 22(1): 35-37.
7. Rainsford KD, Parke AL, Clifford-Rashotte M, et al. Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases. Inflammopharmacology, 2015, 23(5): 1-39.
8. Ruizirastorza G, Ramoscasals M, Britozeron P, et al. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis, 2010, 69(1): 20.
9. Suarezalmazor ME, Belseck E, Shea B, et al. Antimalarials for rheumatoid arthritis. Coch Data Sys Rev, 2001, (2): CD000959.
10. Mostafa WZ. Lichen planus of the nail: treatment with antimalarial. J Am Acad Dermatol, 1989, 20(2 Pt 1): 289.
11. Eisen D. Hydroxychloroquine sulfate (Plaquenil) improves oral lichen planus: An open trial. J Am Acad Dermatol, 1993, 28(4): 609-612.
12. Rivastolosa N, Requena C, Llombart B, et al. Antimalarial drugs for the treatment of oral erosive lichen planus. Dermatology, 2015, 232(1): 86-90.
13. 曹宏康, 张水龙, 徐维宁, 等. 口服氯化喹啉与局注确炎舒松-A 治疗口腔扁平苔藓. 上海口腔医学, 1996, 5(3): 140-142.
14. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Revista Española De Nutrición Humana Y Dietética, 2009, 18(3): e123.
15. 朱聘倬. 清热解毒养阴中药治疗口腔扁平苔藓 62 例-附西药对照组 30 例. 辽宁中医杂志, 2001, 28(12): 728-729.
16. 金早蓉, 秦念红, 陈燕丹, 等. 复方甘草酸苷治疗口腔扁平苔藓的临床疗效观察及免疫机制研究. 齐齐哈尔医学院学报, 2013, 34(9): 1276-1277.
17. 黄晓慧. 苔藓方治疗糜烂型口腔扁平苔藓的临床疗效观察. 郑州: 河南中医药大学, 2009.
18. 王北溟. 益气活血祛湿法治疗口腔扁平苔藓(气虚血瘀湿浊型)的临床研究. 郑州: 河南中医学院, 2006.
19. 李俊荣, 侯文勇, 宫卫星, 等. 复方消苔颗粒治疗口腔扁平苔藓临床观察. 中医药临床杂志, 2012, 24(5): 427-429.
20. 徐帆. 辨证治疗糜烂型口腔扁平苔藓 42 例临床观察. 新中医, 2015, (9): 68-70.
21. 王艳. 加味苔藓饮治疗口腔扁平苔藓疗效观察. 浙江中西医结合杂志, 2010, 20(10): 632.
22. 杨淑琴, 蔡剑, 杨晓霞. 活血化瘀方治疗口腔糜烂型扁平苔藓的临床观察. 口腔医学, 2014, 34(4): 288-290.
23. Bendas ER, Abdullah H, El-Komy MH, et al. Hydroxychloroquine niosomes: a new trend in topical management of oral lichen planus. Int J Pharmaceut, 2013, 458(2): 287.
24. 徐治鸿. 中西医结合口腔黏膜病学(精). 北京: 人民卫生出版社, 2008.
25. Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Brit J Oral Max Surg, 2008, 46(1): 15-21.
26. Crincoli V, Bisceglie MBD, Scivetti M, et al. Oral lichen planus: update on etiopathogenesis, diagnosis and treatment. Immunopharmacol Immunotoxicol, 2011, 33(1): 11.
27. 谢勋, 许国祺. 氯化喹啉在口腔粘膜病中的应用. 口腔医学, 1985, (3): 155-156.
28. 魏太星, 魏经汉. 医生专用药物手册. 郑州: 河南科学技术出版社, 2015.
29. 刘翠萍, 陆春燕, 王文梅. 磷酸氯喹在口腔扁平苔藓中的临床应用. 临床口腔医学杂志, 2003, 19(10): 633-635.
30. 王才惠, 段西凌. 羟氯喹在治疗皮肤病中的应用. 临床皮肤科杂志, 2013, 42(4): 259-261.
31. 赖红昌, 曹宏康, 乐福媛. 口腔扁平苔藓患者 T 细胞亚群、sIL-2R 水平的动态观察. 实用口腔医学杂志, 1997, (4): 9-11, 65.
32. 邓冠红, 陈作良, 陈宏柏, 等. T 细胞免疫和细胞凋亡在口腔扁平苔藓发病中的作用. 华西口腔医学杂志, 2009, 27(3): 256-259.
33. 刘雅菁, 王文梅. 口腔扁平苔藓中 T 淋巴细胞亚群的研究进展. 国际口腔医学杂志, 2011, 38(4): 433-435.
34. 华红, 刘宏伟. 口腔黏膜学. 北京: 北京大学医学出版社, 2014.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of hydroxychloroquine or chloroquine for oral lichen planus:a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content