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：

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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.	中華口腔醫學會口腔黏膜病專業委員會, 中華口腔醫學會中西醫結合專業委員會, 周紅梅. 口腔扁平苔蘚診療指南(試行). 中華口腔醫學雜志, 2012, 47(7): 399-401.
6.	余春曉, 李杏, 孫爾維. 羥氯喹抗風濕病的辛路歷程. 中華風濕病學雜志, 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, 張水龍, 徐維寧, 等. 口服氯化喹啉與局注確炎舒松-A 治療口腔扁平苔蘚. 上海口腔醫學, 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 Espa?ola De Nutrición Humana Y Dietética, 2009, 18(3): e123.
15.	朱聘倬. 清熱解毒養陰中藥治療口腔扁平苔蘚 62 例-附西藥對照組 30 例. 遼寧中醫雜志, 2001, 28(12): 728-729.
16.	金早蓉, 秦念紅, 陳燕丹, 等. 復方甘草酸苷治療口腔扁平苔蘚的臨床療效觀察及免疫機制研究. 齊齊哈爾醫學院學報, 2013, 34(9): 1276-1277.
17.	黃曉慧. 苔蘚方治療糜爛型口腔扁平苔蘚的臨床療效觀察. 鄭州: 河南中醫藥大學, 2009.
18.	王北溟. 益氣活血祛濕法治療口腔扁平苔蘚(氣虛血瘀濕濁型)的臨床研究. 鄭州: 河南中醫學院, 2006.
19.	李俊榮, 侯文勇, 宮衛星, 等. 復方消苔顆粒治療口腔扁平苔蘚臨床觀察. 中醫藥臨床雜志, 2012, 24(5): 427-429.
20.	徐帆. 辨證治療糜爛型口腔扁平苔蘚 42 例臨床觀察. 新中醫, 2015, (9): 68-70.
21.	王艷. 加味苔蘚飲治療口腔扁平苔蘚療效觀察. 浙江中西醫結合雜志, 2010, 20(10): 632.
22.	楊淑琴, 蔡劍, 楊曉霞. 活血化瘀方治療口腔糜爛型扁平苔蘚的臨床觀察. 口腔醫學, 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.	徐治鴻. 中西醫結合口腔黏膜病學(精). 北京: 人民衛生出版社, 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.	謝勛, 許國祺. 氯化喹啉在口腔粘膜病中的應用. 口腔醫學, 1985, (3): 155-156.
28.	魏太星, 魏經漢. 醫生專用藥物手冊. 鄭州: 河南科學技術出版社, 2015.
29.	劉翠萍, 陸春燕, 王文梅. 磷酸氯喹在口腔扁平苔蘚中的臨床應用. 臨床口腔醫學雜志, 2003, 19(10): 633-635.
30.	王才惠, 段西凌. 羥氯喹在治療皮膚病中的應用. 臨床皮膚科雜志, 2013, 42(4): 259-261.
31.	賴紅昌, 曹宏康, 樂福媛. 口腔扁平苔蘚患者 T 細胞亞群、sIL-2R 水平的動態觀察. 實用口腔醫學雜志, 1997, (4): 9-11, 65.
32.	鄧冠紅, 陳作良, 陳宏柏, 等. T 細胞免疫和細胞凋亡在口腔扁平苔蘚發病中的作用. 華西口腔醫學雜志, 2009, 27(3): 256-259.
33.	劉雅菁, 王文梅. 口腔扁平苔蘚中 T 淋巴細胞亞群的研究進展. 國際口腔醫學雜志, 2011, 38(4): 433-435.
34.	華紅, 劉宏偉. 口腔黏膜學. 北京: 北京大學醫學出版社, 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. 中華口腔醫學會口腔黏膜病專業委員會, 中華口腔醫學會中西醫結合專業委員會, 周紅梅. 口腔扁平苔蘚診療指南(試行). 中華口腔醫學雜志, 2012, 47(7): 399-401.
6. 余春曉, 李杏, 孫爾維. 羥氯喹抗風濕病的辛路歷程. 中華風濕病學雜志, 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, 張水龍, 徐維寧, 等. 口服氯化喹啉與局注確炎舒松-A 治療口腔扁平苔蘚. 上海口腔醫學, 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 Espa?ola De Nutrición Humana Y Dietética, 2009, 18(3): e123.
15. 朱聘倬. 清熱解毒養陰中藥治療口腔扁平苔蘚 62 例-附西藥對照組 30 例. 遼寧中醫雜志, 2001, 28(12): 728-729.
16. 金早蓉, 秦念紅, 陳燕丹, 等. 復方甘草酸苷治療口腔扁平苔蘚的臨床療效觀察及免疫機制研究. 齊齊哈爾醫學院學報, 2013, 34(9): 1276-1277.
17. 黃曉慧. 苔蘚方治療糜爛型口腔扁平苔蘚的臨床療效觀察. 鄭州: 河南中醫藥大學, 2009.
18. 王北溟. 益氣活血祛濕法治療口腔扁平苔蘚(氣虛血瘀濕濁型)的臨床研究. 鄭州: 河南中醫學院, 2006.
19. 李俊榮, 侯文勇, 宮衛星, 等. 復方消苔顆粒治療口腔扁平苔蘚臨床觀察. 中醫藥臨床雜志, 2012, 24(5): 427-429.
20. 徐帆. 辨證治療糜爛型口腔扁平苔蘚 42 例臨床觀察. 新中醫, 2015, (9): 68-70.
21. 王艷. 加味苔蘚飲治療口腔扁平苔蘚療效觀察. 浙江中西醫結合雜志, 2010, 20(10): 632.
22. 楊淑琴, 蔡劍, 楊曉霞. 活血化瘀方治療口腔糜爛型扁平苔蘚的臨床觀察. 口腔醫學, 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. 徐治鴻. 中西醫結合口腔黏膜病學(精). 北京: 人民衛生出版社, 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. 謝勛, 許國祺. 氯化喹啉在口腔粘膜病中的應用. 口腔醫學, 1985, (3): 155-156.
28. 魏太星, 魏經漢. 醫生專用藥物手冊. 鄭州: 河南科學技術出版社, 2015.
29. 劉翠萍, 陸春燕, 王文梅. 磷酸氯喹在口腔扁平苔蘚中的臨床應用. 臨床口腔醫學雜志, 2003, 19(10): 633-635.
30. 王才惠, 段西凌. 羥氯喹在治療皮膚病中的應用. 臨床皮膚科雜志, 2013, 42(4): 259-261.
31. 賴紅昌, 曹宏康, 樂福媛. 口腔扁平苔蘚患者 T 細胞亞群、sIL-2R 水平的動態觀察. 實用口腔醫學雜志, 1997, (4): 9-11, 65.
32. 鄧冠紅, 陳作良, 陳宏柏, 等. T 細胞免疫和細胞凋亡在口腔扁平苔蘚發病中的作用. 華西口腔醫學雜志, 2009, 27(3): 256-259.
33. 劉雅菁, 王文梅. 口腔扁平苔蘚中 T 淋巴細胞亞群的研究進展. 國際口腔醫學雜志, 2011, 38(4): 433-435.
34. 華紅, 劉宏偉. 口腔黏膜學. 北京: 北京大學醫學出版社, 2014.

Chinese Journal of Evidence-Based Medicine

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

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