title: Biologics in oral medicine: ulcerative disorders.
abstract: Inflammatory ulcerative diseases of the oral mucosa are wide ranging but include especially aphthous and aphthous-like ulceration, vesiculobullous disorders and erosive lichen planus (LP). While most patients with these conditions respond to conventional topical and/or systemic immunosuppressive agents, treatment-resistant cases remain challenging. In these, the use of biologics such as tumour necrosis factor alpha (TNF-α) inhibitors or rituximab may be of benefit. This article reviews the use of biologics in ulcerative oral conditions, highlighting potential benefits, adverse effects and principles of use and future developments. TNF-α inhibitors such as infliximab can be effective in inducing resolution in oral aphthous and aphthous-like ulcers and may be an appropriate therapy in those patients in which disease is severe and refractory to, or patients are intolerant of, traditional immunomodulatory regimens. There would also seem support and rationale for use of biologics (mainly rituximab) in pemphigus but not in oral LP or other oral ulcerative conditions.
authors.affiliation: Centre d'Affaires Poincaré, Nice, France. iain.oneill@hotmail.com
authors.forename: I D
authors.initials: ID
authors.lastname: O'Neill
authors.forename: C
authors.initials: C
authors.lastname: Scully
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D001768:Blister / Q000188:drug therapy; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D017676:Lichen Planus, Oral / Q000188:drug therapy; D019226:Oral Ulcer / Q000188:drug therapy*; D000069283:Rituximab; D013281:Stomatitis, Aphthous / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D001688:Biological Products; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab