title: Management of oral Graft versus Host Disease with topical agents: A systematic review.
abstract: BACKGROUND
  Oral Graft-versus-Host Disease (oGvHD) is a common complication of haematopoietic stem cell transplantation. Choosing the right topical application to be used intra orally can be a challenge. Consequently, the aim of this work is to review the effectiveness and safety of topical agents currently used in the management of the inflammatory mucosal lesions encountered in oGVHD.
  
  
  METHODS
  We carried out electronic searches of publications up to May 2015 of the databases Pubmed, National Library of Medicine's Medline, Embase and the Cochrane Central Register of Controlled Clinical trials to identify potentially relevant studies (keywords: "oral", "graft", "versus", "host", "disease" and "treatment"). The main inclusion criterion was the reported use of a topical agent which was not intentionally swallowed when used for the treatment of oGVHD. A 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care and the Centre for Reviews and Dissemination, University of York, was used to rate the methodological quality of the papers.
  
  
  RESULTS
  From the 902 entries identified in the search, 7 studies qualifying for inclusion were analysed. Overall, there is limited evidence with regards to the effectiveness of topical steroids for oGVHD. However, the studies showed some effect of Budesonide alone and when combined with dexamethasone. Topical tacrolimus also appears to have some effect and clobetasol propionate mouthwash had a significantly better clinical response than dexamethasone mouthwash in treating oGVHD.
  
  
  CONCLUSIONS
  As the number of clinical trials conducted is limited, there is little evidence to support the use of topical therapies to treat the inflammatory mucosal lesions found in oGVHD. High quality randomised control trials are needed in order to measure the effectiveness of any topical application for the treatment of the inflammatory mucosal lesions found in oGVHD.
authors.affiliation: Oral Medicine Department, Birmingham Dental Hospital/School of Dentistry, University of Birmingham, Birmingham B4 6NN, UK, R.P.P.D.Albuquerque@bham.ac.uk.
authors.forename: Rui
authors.initials: R
authors.lastname: Albuquerque
authors.forename: Zahid
authors.initials: Z
authors.lastname: Khan
authors.forename: Ana
authors.initials: A
authors.lastname: Poveda
authors.forename: Jonathan
authors.initials: J
authors.lastname: Higham
authors.forename: Andrea
authors.initials: A
authors.lastname: Richards
authors.forename: Luis
authors.initials: L
authors.lastname: Monteiro
authors.forename: Enric
authors.initials: E
authors.lastname: Jané-Salas
authors.forename: José
authors.initials: J
authors.lastname: Lopez-Lopez
authors.forename: Saman
authors.initials: S
authors.lastname: Warnakulasuriya
mesh_terms: D000287:Administration, Topical; D005938:Glucocorticoids / Q000008:administration & dosage*; D006086:Graft vs Host Disease / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D009059:Mouth Diseases / Q000188:drug therapy*
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents