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Efficacy of Topical Agents in Oral Mucositis Prevention
TAKE-HOME MESSAGE
- In this systematic review and network meta-analysis designed to evaluate the efficacy of topical agents in the prevention of oral mucositis (OM), sucralfate use significantly reduced the incidence of OM following cancer treatment. Considerable differences in the frequency and severity of OM were observed between the sucralfate and control groups.
- Sucralfate mouthwash may be recommended for the management of cancer therapy–induced OM, considering its low cost, easy administration, satisfactory compliance, and lack of association with significant adverse effects. Given its cytoprotective properties, sucralfate use represents a highly promising agent for the prevention or treatment of cancer therapy–induced OM.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Oral mucositis (OM) is considered one of the most common side effects of patients undergoing cancer therapy. OM prevention plays a crucial role in the effectiveness of cancer treatment and the patient's quality of life. Different preventive treatments have been proposed in clinical trials, however with inconclusive results.
MATERIALS AND METHODS
A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: in cancer patients, do specific topical agents compared to standard treatments or placebo reduce the onset and severity of oral mucositis? The risk of bias was assessed, and a network meta-analysis was conducted.
RESULTS
Of 2913 results, 30 randomized clinical trials were considered suitable for inclusion. A total of 2564 patients were analyzed, of which 1284 belonged to the test group and 1280 belonged to the control group. Natural products were the most used, followed mainly by antimicrobial agents, coating agents, and basic oral care measures. Topical sucralfate resulted in the most powerful intervention for the OM prevention (OR = 0.04, 95%C.I. = 0.01-0.25, p-value = 0.001).
CONCLUSION
Due to its cytoprotective action, low cost, ease of administration, and safety, sucralfate could become a potential ally to prevent the onset of OM during cancer therapy.
Additional Info
Efficacy of topical agents in oral mucositis prevention: Systematic review and network meta-analysis
Oral Dis 2024 Jun 24;[EPub Ahead of Print], M Coppini, VCA Caponio, R Mauceri, ME Bizzoca, L Laino, AI Lorenzo-Pouso, D Russo, G Troiano, FFVE Silva, L Lo Muzio, G CampisiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study aimed to investigate the efficacy of different approaches to decrease the impact of oral mucositis (OM). The clinical presentation of OM among patients being treated for cancer can be severe and result in treatment interruption. This study is an arm-based network meta-analysis comprising 30 randomized clinical trials published between 1990 and 2022, including an international multicenter study. A total of 2564 patients were included, of whom 1280 were in the control group and 1284 were in the test group. All patients were diagnosed with head and neck, gastrointestinal, or breast cancer. Patients in the control group were exposed to placebo and standard treatment, and those in the test group were exposed to an array of interventions.
The test group interventions included povidone-iodine mouthwash; a paste containing colistin sulfate, tobramycin, and 1% amphotericin B; sucralfate mouthwash; Lactobacillus brevis CD2 lozenges; MuGard®; honey topical application; curcumin; aloe vera; tea; grape seed extract; and propolis. The authors also evaluated the effects of benzydamine mouthwash, misoprostol, and allopurinol mouthwash as anti-inflammatory and analgesic agents.
The control group interventions included sterile water, NaCl solution, povidone-iodine, sodium bicarbonate, benzydamine, and lignocaine mouthwashes.
Some considerations to keep in mind
Sucralfate mouthwash was determined to be the most powerful method to decrease the incidence of OM, despite the International Society for Oral Oncology advisory recommending caution when using sucralfate. The mechanism of action may be sucralfate’s molecular interactions that facilitate tissue repair. Other approaches such as MuGard®, curcumin, CD2 lozenges, and grape seed extract were also of some benefit.
Given the variety of treatments that were evaluated in this study in different populations, the study presents helpful information for the clinician in managing OM.