title: Combined topical dexamethasone/tacrolimus therapy for management of oral chronic GVHD.
abstract: Chronic GVHD (cGVHD) frequently affects the oral cavity. The purpose of this study was to estimate the efficacy of combined topical dexamethasone (DEX) and tacrolimus (TAC) solutions in the management of oral cGVHD. The records of 14 patients with oral cGVHD treated with combined topical DEX/TAC were reviewed retrospectively. Pre-to-post treatment changes in subjective and objective measures were evaluated at a median follow-up of 60 days. Serum TAC levels were examined. Marginal objective improvement was detected at follow-up. The median pre-to-post treatment differences were 0.5 (range, -1 to 1) for erythema score, and 0.5 (range, 0 to 2) for lichenoid score, (P=0.06, 0.07 and 0.02, respectively). Subjective improvement was noted in three of four measures at the follow-up visit. The median differences in pain, sensitivity and dryness scores were 1 (range -1 to 6), 1 (range -3 to 5) and 2.5 (range, -5 to 5), respectively (0-10 scale, P<0.05). Four patients (37%) showed increased serum TAC levels; however, all remained within therapeutic range. In conclusion, combined topical DEX/TAC therapy appears to be effective in reducing symptoms attributable to oral cGVHD. Our data has shown minimal evidence of systemic TAC absorption.
authors.affiliation: Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA. hmawardi@partners.org
authors.forename: H
authors.initials: H
authors.lastname: Mawardi
authors.forename: K
authors.initials: K
authors.lastname: Stevenson
authors.forename: B
authors.initials: B
authors.lastname: Gokani
authors.forename: R
authors.initials: R
authors.lastname: Soiffer
authors.forename: N
authors.initials: N
authors.lastname: Treister
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004890:Erythema; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents; D017512:Lichenoid Eruptions; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology*; D010146:Pain; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003907:Dexamethasone; D016559:Tacrolimus