topical corticosteroid in management of graft versus host disease

Background: Oral chronic Graft versus host disease (cGVHD) is a major complication in transplantation community, a problem that can be addressed with topical intervention. Treatment is aimed at pain relief and the promotion of healing. Topical corticosteroids is the first line of 1 2 treatment although the choice remains challenging as none of the available topical treatments is supported by strong clinical evidence. Objective This systematic review aims to determine the clinical efficacy and safety of topical corticosteroids for the management of the mucosal alterations of oral cGVHD. Data Sources We conducted an electronic search of different databases: PubMed, Cochrane library, Grey literature, WHO and Clinical trial.gov for clinical trial registration as well as hand search in the references of relevant articles up to November 2016. Study selection and data extraction: We included all clinical trials reporting the use of topical corticosteroids for management of oral chronic GVHD. Extracted information from each study were intervention, population, sample sizes, outcomes, study quality, level of evidence Data synthesis: six studies were included 2 Randomized clinical trial (RCT), 3cohort, 1 pre-post clinical trial. Results: The results showed that there is a limited evidence concerning clinical efficacy of topical corticosteroids. Clobetasol, Dexamethasone and budesonide were the topical corticosteroid of choice in all searched evidences. The highest level of evidence score was given to Clobetasol stating a better clinical results for efficacy and safety as well. This is followed by budesonide reporting a promising clinical efficacy with a lower evidence level. Conclusion: all three topical corticosteroid preparations are effective for management of oral chronic GVHD with minimal easily avoided side effects.