Efficacy and safety of apremilast versus dapsone versus colchicine in recurrent aphthous stomatitis: a three arm double blinded comparative study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20240520Keywords:
Aphthous ulcer, Apremilast, Colchicine, DapsoneAbstract
Background: Recurrent aphthous stomatitis (RAS) is often considered as an incurable ailment. Therefore, an effective management option is required for controlling the symptoms and severity of RAS. We aimed to conduct a study to compare the effectiveness and safety profile of apremilast, dapsone and colchicine in management of RAS.
Methods: This three-arm double blinded comparative study included 60 cases of recurrent aphthous stomatitis (RAS). Twenty patients each were randomly allocated in three groups: group A (apremilast), group B (dapsone) and group C (colchicine).
Results: At the end of 6 weeks, the complete response was seen in 6 (30%) patients in group A as compared to 2 (10%) and 4 (20%) patients in group B and C (p >0.05). At the end of 12 weeks, response rate became statistically significant (p=0.003) with complete response in 14 (70%) of patients. Median time to recurrence, defined as oral ulcer after loss of complete response, was significantly increased to 4.3 weeks in group A as compared to group B and C. The most commonly encountered side effects were gastrointestinal in all three groups. None of the adverse effects resulted in discontinuation of treatment, hospitalization or death in any patient.
Conclusions: Although, traditional therapies like dapsone and colchicine have been commonly used in clinical practice, apremilast yielded a rapid and maintained improvement of RAS.
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References
Sánchez-Bernal J, Conejero C, Conejero R. Recurrent aphthous stomatitis. Actas Dermosifiliogr. 2020;111(6):471-80.
Chiang CP, Yu-Fong Chang J, Wang YP, Wu YH, Wu YC, Sun A. Recurrent aphthous stomatitis- etiology, serum autoantibodies, anemia, hematinic deficiencies, and management. J Formos Med Assoc. 2019;118(9):1279-89.
Femiano F, Lanza A, Buonaiuto C, Gombos F, Nunziata M, Piccolo S, Cirillo N. Guidelines for diagnosis and management of aphthous stomatitis. Pediatr Infect Dis J. 2007;26(8):728-32.
Belenguer-Guallar I, Jiménez-Soriano Y, Claramunt-Lozano A. Treatment of recurrent aphthous stomatitis. A literature review. J Clin Exp Dent. 2014;6(2):e168-74.
Porter SR, Scully C. Aphthous stomatitis- an overview of aetiopathogenesis and management. Clin Exp Dermatol. 1991;16:235-43.
Abdulrahman HS, Mutaz FF. Therapeutic management of recurrent aphthous stomatitis: a review of the growing knowledge. Ann Int Med Dent Res. 2016;2:1-9.
Schibler F, Heidemeyer K, Klötgen HW, Keshavamurthy V, Yawalkar N. Apremilast for treatment of recalcitrant aphthous stomatitis. JAAD Case Rep. 2017;3(5):410-1.
Hatemi G, Melikoglu M, Tunc R, Korkmaz C, Turgut Ozturk B, Mat C, et al. Apremilast for Behçet's syndrome--a phase 2, placebo-controlled study. N Engl J Med. 2015;372(16):1510-8.
Mimura MA, Hirota SK, Sugaya NN, Sanches JA Jr, Migliari DA. Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial. Clinics. 2009;64(3):193-8.
Lynde CB, Bruce AJ, Rogers RS. Successful treatment of complex aphthosis with colchicine and dapsone. Arch Dermatol. 2009;145(3):273-6.
Sharquie KE, Najim RA, Abu‐Raghif AR. Dapsone in Behçet’s disease: a double‐blind, placebo‐controlled, cross‐over study. J Dermatol. 2002;29(5):267-79.
Edgar NR, Saleh D, Miller RA. Recurrent aphthous stomatitis: a review. J Clin Aesthet Dermatol. 2017;10(3):26-36.
Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134(2):200-7.