No quality evidence on how to manage mouth ulcers in patients with Behçet’s disease

Behçet’s disease is a chronic disease characterised by a multitude of signs and symptoms including oral and genital ulcerations, skin lesions and inflammatory vascular involvement of the central nervous system and gastrointestinal tract. Although the underlying cause of Behçet’s disease is unknown it is thought to involve a genetic predisposition combined with environmental factors. Behçet’s disease most commonly presents in the third decade. The disease is rare in individuals older than age 50 years and during childhood. Although both sexes are equally affected, it is thought that the disease has a more severe course amongst men. The mouth ulcers that occur in Behçet’s disease can be painful and slow to heal. At their worst, they can cause significant difficulties in eating and drinking. This systematic review looks at the evidence on how to manage these ulcers, but found that there was no high quality evidence to make recommendations for any one particular treatment.

What was the research?

A systematic review of the evidence to find out the effects of different treatments for mouth ulcers in people with Behçet’s disease. The review also looked at ways to prevent the ulcers from developing.

Who conducted the research?

The research was conducted by a team led by Jennifer Taylor from the University of Manchester, on behalf of the Cochrane Oral Health Group. Anne-Marie Glenny, Tanya Walsh, Paul Brocklehurst, Philip Riley, Rachel Gorodkin and Michael N. Pemberton were also on the team.

What evidence was included in the review?

Data was extracted from 15 randomised controlled trials. A total of 888 people participated in the trials, the majority of which (11) took place in Turkey. Two took place in Japan, one in Iran and one in the UK. Thirteen different interventions were assessed, including sucralfate, interferon-alpha, cyclosporin A, aciclovir, thalidomide and corticosteroids. 5 of the trials compared the treatment to a placebo, the rest looked at one treatment versus another.

What did the evidence say?

The trials were very different from one another, and it was not possible to pool the data from them into a meta-analysis. There was not enough evidence to support or refute the use of any of the included interventions with regard to pain, how long the ulcers lasted or how often the ulcers came back. There was also not enough data to assess the safety of each intervention.

How good was the evidence?

Only one of the trials was assessed by the team as being at low risk of bias. The quality of the rest of the evidence ranged from moderate to very low. However, several of the interventions did show promise.

What are the implications for dentists and the general public?

There is insufficient evidence to support or refute the use of any of the interventions included in this review.

What should researchers look at in the future?

This review was limited by the poor methodology of many of the trials, which were very different from one another. The trials looked at different outcomes and many reported the results inadequately. Future trials should be appropriately planned, executed and reported according to CONSORT guidance. The development of a set of standardised outcome measures for mouth ulcer trials (currently registered with COMET) should help in planning future studies.

Link

Citation example: Taylor J, Glenny A-M, Walsh T, Brocklehurst P, Riley P, Gorodkin R, Pemberton MN. Interventions for the management of oral ulcers in Behçet’s disease. Cochrane Database of Systematic Reviews 2014 , Issue 9 . Art. No.: CD011018. DOI: 10.1002/14651858.CD011018.pub2