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Meta-Analysis
. 2024 Sep 28;24(1):1149.
doi: 10.1186/s12903-024-04923-1.

Efficacy and safety of thalidomide for recurrent aphthous stomatitis: a systematic review and meta-analysis of randomized controlled trials

Yang Jian  1 , Fuqin Wang  1 , Minru Zhao  1 , Xianru Han  1 , Xiaoyu Wang  2
Affiliations
Meta-Analysis

Efficacy and safety of thalidomide for recurrent aphthous stomatitis: a systematic review and meta-analysis of randomized controlled trials

Yang Jian et al. BMC Oral Health. .

Abstract

Background: Recurrent aphthous stomatitis (RAS) is considered as the most common oral mucosal lesion affecting up to 25% of people worldwide. Thalidomide has been reported for the treatment of RAS, but the evidence has not been systematically evaluated. We first systematically reviewed the efficacy and safety of thalidomide for the treatment of RAS.

Methods: We searched The Cochrane Library, PubMed, Scopus, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database (CBM), Wanfang Data, and VIP information from inception to December 2023. Randomized controlled trials (RCTs) comparing thalidomide with control for RAS were included in the analysis. The primary outcome were complete response and overall response, and the secondary outcome were recurrence interval (RI), ulcer number and size, healing time, visual analogue scale (VAS), immunological data, and adverse events. Meta-analysis was conducted using the Review Manager 5.4 software.

Results: Twenty-one trials involving 1668 patients were included in this review. The results of our meta-analysis showed that thalidomide significantly improved the complete response rate and overall response rate, prolonged the recurrence interval, accelerated the healing process, reduced the number and size of ulcers, and lowered TNF-α levels in the treatment of RAS. However, thalidomide significantly increases adverse events.

Results: Thalidomide has a significant benefit in the treatment of RAS. However, considering the potential side effects of thalidomide, it may be an optimal treatment option for major RAS patients or cases that do not respond to topical agents.

Trial registration: PROSPERO registration number: CRD42024495038.

Keywords: Meta-analysis; Recurrent aphthous stomatitis; Stomatitis, Aphthous; Systematic review; Thalidomide.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection process RCT = Randomized controlled trial, CNKI = China National Knowledge Infrastructure, CBM = Chinese BioMedical Literature Database
Fig. 2
Fig. 2
Risk of bias graph of included RCTs
Fig. 3
Fig. 3
Forest plot of thalidomide group versus control group in complete response rate for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval. a thalidomide vs. placebo, b thalidomide vs. other drugs, c thalidomide + other drugs vs. other drugs alone
Fig. 4
Fig. 4
Forest plot of thalidomide group versus control group in overall response rate for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval. a thalidomide vs. placebo, b thalidomide vs. other drugs, c thalidomide + other drugs vs. other drugs alone
Fig. 5
Fig. 5
Forest plot of thalidomide group versus control group in recurrence interval changes for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval
Fig. 6
Fig. 6
Forest plot of thalidomide group versus control group in healing time for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval
Fig. 7
Fig. 7
Forest plot of thalidomide group versus control group in ulcer number for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval
Fig. 8
Fig. 8
Forest plot of thalidomide group versus control group in ulcer size for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval
Fig. 9
Fig. 9
Forest plot of thalidomide group versus control group in VAS score for RAS treatment. RAS = recurrent aphthous stomatitis, CI = confidence interval
Fig. 10
Fig. 10
Forest plot of thalidomide group versus control group in adverse effects for RAS treatment
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