Efficacy of intralesional platelet-rich plasma versus intralesional corticosteroids in the management oral lichen planus: A systematic review and meta-analysis of randomized controlled trials using random effects and weighted least square methods

Abstract

Aim: This systematic review and meta-analysis aimed to compare the efficacy of intralesional platelet-rich plasma and intralesional steroids in managing oral lichen planus, focusing on pain and lesion size reduction.

Methodology: A systematic search of MEDLINE (via PubMed), Web of Science, Scopus, and Embase was conducted up to May 30, 2024, to identify randomized controlled trials (RCTs) comparing the efficacy of intralesional platelet-rich plasma (PRP) and intralesional steroids in managing oral lichen planus (OLP). The study adhered to a predefined PICOS framework: (P) adults diagnosed with OLP, (I) PRP application, (C) steroid application, (O) outcomes related to pain reduction and lesion size, and (S) RCTs. The analysis utilized both random-effects and Weighted Least Squares (WLS) models to account for heterogeneity and assess publication bias.

Results: Seven articles met the eligibility criteria, of which six were included in the meta-analysis, encompassing 141 participants. While the analysis was limited by a small sample size, significant heterogeneity, and a lack of long-term follow-up, analysis with random-effects and WLS model provided a robust comparative evaluation of PRP and steroids for OLP treatment. Pain Reduction: The pooled effect size was -0.34 (95% CI: -0.94 to 0.27; p = 0.274), indicating a moderate, non-significant preference for steroids over PRP. Moderate to high heterogeneity (I² = 68.516%) suggested substantial variability in effect sizes. Lesion Size Reduction: The pooled effect size was -0.10 (95% CI: -0.58 to 0.39; p = 0.697), favoring PRP slightly but without statistical significance. Low to moderate heterogeneity (I² = 31.42%) was observed.

Conclusion: PRP demonstrated comparable efficacy to steroids in reducing pain and lesion size in OLP patients, with the added advantage of fewer side effects. However, significant heterogeneity and publication bias necessitate further high-quality research to substantiate these findings.