Efficacy and safety of topical administration of tacrolimus in oral lichen planus: An updated systematic review and meta-analysis of randomized controlled trials

Background Symptomatic oral lichen planus is a common chronic T-cell-mediated disorder characterized by pain and inflammation. The meta-analysis aimed to compare and evaluate the effects and safety of tacrolimus for treating patients with symptomatic oral lichen planus. Methods A comprehensive literature review was performed, including PubMed, the Cochrane Library, Embase, and Web of Science published up to and including December 2020. ClinicalTrials.gov was searched for ongoing trials. There were no restrictions on language or date of publication. Using the Cochrane Collaboration tool, we assessed the risk of bias for randomized controlled trials and estimated the proportion of between-trial heterogeneity. Results A total of 9 RCTs evaluating the effects of tacrolimus were included in this study. The results revealed no significant difference in clinical resolution and relapse between tacrolimus and corticosteroids. However, tacrolimus may be more likely to cause mild adverse effects. In particular, clinical resolution was not significantly different between tacrolimus and clobetasol propionate, and between tacrolimus and triamcinolone acetonide, while tacrolimus was more likely to cause adverse effects than triamcinolone acetonide and clobetasol propionate. Moreover, there was no significant difference in pain resolution between tacrolimus and clobetasol. Furthermore, adverse effects were not significantly different between tacrolimus and pimecrolimus. Conclusions This systematic review and meta-analysis of 9 clinical trials supported the short-term application of tacrolimus as an effective regimen in OLP patients resistant to other topical and systemic therapies. Furthermore, the adverse effects of tacrolimus were minor and transient and did not affect tacrolimus' continued application.