Comparing the efficacy of topical interventions for pain management in oral lichen planus: a time-stratified bayesian network analysis of randomized controlled trials.

Abstract

Background: The evaluation of short-term pain relief provided by newly developed drugs for the treatment of oral lichen planus is currently limited. The primary aim of this study was to establish a clinically relevant hierarchy among different treatments in terms of their effectiveness for short-term pain control.

Methods: EMBASE, Scopus, PubMed, WanFang database, and Cochrane databases were searched up to January 2025. A Bayesian network meta-analysis (NMA) was conducted using Stata/SE 15.1 software. The primary outcome was the reduction in pain severity, and the secondary outcome was the improvement in clinical sign scores. The Cochrane Risk of Bias Tool was used to assess the risk of bias, and confidence in network meta-analysis(CINeMA) was employed to evaluate the confidence in evidence. NMA was performed in Stata within a frequentist framework, and heterogeneity and inconsistency were assessed. Heterogeneity, inconsistency, and sensitivity were analyzed, with comprehensive efficacy rankings derived from surface under the cumulative ranking curve (SUCRA) values.

Results: Sixty-four randomized trials (2,839 participants) evaluating 24 interventions were included. Corticosteroids and immunosuppressants demonstrated significant efficacy in pain control and sign score improvement. Topical laser therapy and plant-based agents (e.g. Chamomile) emerged as effective alternatives, particularly for early-to-mid stage symptom management.

Conclusions: Based on the evidence, highly effective topical corticosteroids are preferred, and immunosuppressants can be used when corticosteroids are ineffective or cause adverse effects, both in terms of pain control and sign score reduction. Phototherapy and botanicals offer favorable safety profiles for sustained use. Future research should focus on exploring more effective administration methods and combination therapies with fewer side effects.

Clinical significance: This NMA provides a time-dependent therapeutic hierarchy for oral lichen planus management, addressing gaps in comparative effectiveness evidence. While limitations exist in long-term outcome data, findings support personalized treatment sequences based on symptom severity and treatment phase.

Trial registration: The systematic review protocol has been registered in advance with the PROSPERO database (CRD42020197486).