Jacqueline W Mays1, Barbara P Carey2, Rachael Posey3, Luiz Alcino Gueiros4, Katherine France5, Jane Setterfield2, Sook Bin Woo6, Thomas P Sollecito5, Donna Culton7, Aimee S Payne8, Martin S Greenberg5, Scott De Rossi9. 1. Oral Immunobiology Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland. 2. Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK. 3. William Rand Kenan, Jr. Library of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina. 4. Oral Medicine Unit, Department of Clinic and Preventive Dentistry, Universidade Federal de Pernambuco, Recife, Brazil. 5. Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania. 6. Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts. 7. Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 8. Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. 9. School of Dentistry, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Abstract
OBJECTIVE: To assess the evidence for treatment of oral involvement of pemphigus and pemphigoid with biologics. STUDY DESIGN: This systematic review used a comprehensive search strategy to identify literature describing oral involvement of pemphigus or pemphigoid treated with a biologic agent. The primary outcome measures were efficacy and safety of biologic therapy. RESULTS: Inclusion criteria were met by 154 studies including over 1200 patients. Treatment of pemphigus with a total of 11 unique biologic agents and 3 unique combinations of agents is reported. Five randomized controlled trials (RCT) were included in the final analysis that investigated infliximab, IVIg, rituximab, and autologous platelet-rich plasma therapy for pemphigus vulgaris. Three non-RCT studies reported on successful rituximab or IVIg therapy for mucous membrane pemphigoid. Studies demonstrated considerable heterogeneity in agent, methods, and quality. CONCLUSIONS: Evidence clearly describing oral tissue response to biologic therapy is sparse. Two RCTs support use of rituximab, one supports use of IVIg, and one pilot study suggests intralesional injection of autologous platelet-rich plasma aids healing of oral PV lesions. As oral lesions of pemphigus and pemphigoid can be refractory to systemic therapy, drug trials including biologic therapies should document details regarding response of the oral lesions to therapy.
OBJECTIVE: To assess the evidence for treatment of oral involvement of pemphigus and pemphigoid with biologics. STUDY DESIGN: This systematic review used a comprehensive search strategy to identify literature describing oral involvement of pemphigus or pemphigoid treated with a biologic agent. The primary outcome measures were efficacy and safety of biologic therapy. RESULTS: Inclusion criteria were met by 154 studies including over 1200 patients. Treatment of pemphigus with a total of 11 unique biologic agents and 3 unique combinations of agents is reported. Five randomized controlled trials (RCT) were included in the final analysis that investigated infliximab, IVIg, rituximab, and autologous platelet-rich plasma therapy for pemphigus vulgaris. Three non-RCT studies reported on successful rituximab or IVIg therapy for mucous membrane pemphigoid. Studies demonstrated considerable heterogeneity in agent, methods, and quality. CONCLUSIONS: Evidence clearly describing oral tissue response to biologic therapy is sparse. Two RCTs support use of rituximab, one supports use of IVIg, and one pilot study suggests intralesional injection of autologous platelet-rich plasma aids healing of oral PV lesions. As oral lesions of pemphigus and pemphigoid can be refractory to systemic therapy, drug trials including biologic therapies should document details regarding response of the oral lesions to therapy.
Authors: Andy Trotti; A Dimitrios Colevas; Ann Setser; Valerie Rusch; David Jaques; Volker Budach; Corey Langer; Barbara Murphy; Richard Cumberlin; C Norman Coleman; Philip Rubin Journal: Semin Radiat Oncol Date: 2003-07 Impact factor: 5.934