Treatment of oral mucosal manifestations of chronic graft-versus-host disease: dexamethasone vs. budesonide

ABSTRACT

Introduction: The oral mucosa is commonly involved in chronic graft-versus-host disease (cGVHD). Oral mucosal cGVHD markedly affect individual’s daily function and wellbeing. In some cases, it might become a life threating complication.

Areas covered: This article describes the rationale for treatment, method of topical application in the oral cavity, evidence supporting the topical administration of dexamethasone and budesonide for oral cGVHD, and their adverse effects.

Expert opinion: Evidence supports the use of topical dexamethasone and budesonide for treatment of oral cGVHD. Topical corticosteroid choice for oral cGVHD, takes into consideration the potency, bioavailability, preferred concentration, and possible adverse effects. Budesonide’s pharmacological characteristics mark it as a preferable topical agent for oral cGVHD.

KEYWORDS:

• Budesonide
• chronic graft-versus-host disease
• dexamethasone
• hematopoietic stem cell transplantation
• oral medicine
• oral
• mucosa
• pain

Article highlights

• Chronic graft-versus-host disease (cGVHD) is an allo-immune mediated disease, a major late complication of allogeneic hematopoietic stem cell transplantation.

• Oral and peri-oral tissues are the most frequently affected sites in cGVHD patients.

• Intense pain, impaired eating, disturbed speech are some consistent complications associated with cGVHD and strongly affect patients’ quality of life and well-being.

• Corticosteroids are the mainstay of oral cGVHD therapy and may be given locally or systemically. Immune suppression and adverse effects of systemic steroids usage can be spared when locally applied.

• Oral mucosal cGVHD patients may improve with topically applied dexamethasone or budesonide.

• Budesonide, in comparison to other topical steroids, shows pharmacological advantages.

This box summarizes key points contained in the article.

Declaration of interest

Y. Zadik is a coinvestigator, S. Elad is the medical expert, and M. Shapira is a site principal investigator for the study clinicalTrials.gov NCT00887263 sponsored by Dr. Falk Pharma GmbH. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.