Comparison of the Efficacy of Topical Triamcinolone in Orabase and Curcumin in Orabase in Oral Graft-versus-Host Disease
Objectives: Graft-versus-host disease (GVHD) is among the most frequent complications of allogeneic hematopoietic stem cell transplantation (HSCT). GVHD has several clinical manifestations in the oral cavity, including painful desquamative erythema, ulcerative mucosal lesions, and lichenoid lesions. The patients presenting with oral GVHD complain of oral sensitivity, pain, dysgeusia, and xerostomia. The treatment of oral GVHD includes a proper systemic therapy combined with a good oral hygiene and the use of local and topical steroids. Corticosteroids and immunosuppressants are used for the treatment of chronic oral GVHD; however, they are associated with different complications. Evidence shows that curcumin has anti-inflammatory and antioxidative properties. The treatment of lichen planus and oral mucositis with curcumin has been successful. This study aimed to compare the efficacy of topical curcumin in Orabase and triamcinolone in Orabase in the patients affected by oral GVHD.
Materials and Methods: Twenty-six patients presenting with oral GVHD were randomly divided into two groups of 13 using block randomization. The control group used triamcinolone in Orabase, and the case group received curcumin in Orabase.
Results: The two groups were not significantly different in terms of the alleviated severity of the lesions at the end of the treatment (P=0.052). The comparison of the pain score via the visual analog scale (VAS) at the onset of the treatment and at days 14 and 28 (completion of the treatment) showed no significant difference between the two groups (P>0.05).
Conclusions: Curcumin has comparable efficacy to that of triamcinolone and may be prescribed for the patients presenting with oral GVHD.
Ferrara JL, Deeg HJ. Graft-versus-host disease. N Engl J Med. 1991 Mar;324(10):667–74.
Jaglowski SM, Devine SM. Graft-versus-host disease: why have we not made more progress? Curr Opin Hematol. 2014;21(2):141-7.
Kuten-Shorrer M, Woo SB, Treister NS. Oral graft-versus-host disease. Dent Clin North Am. 2014 Mar;58(2):351-68.
Dignan FL, Amrolia P, Clark A, Cornish J, Jackson G, Mahendra P, et al. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol. 2012 Jul;158(1):46-61.
Demarosi F, Lodi G, Carrassi A, Soligo D, Sardella A. Oral malignancies following HSCT: graft versus host disease and other risk factors. Oral Oncol. 2005 Oct;41(9):865-77.
Treister NS, Cook EF, Jr., Antin J, Lee SJ, Soiffer R, Woo SB. Clinical evaluation of oral chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2008 Jan;14(1):110-5.
Deeg HJ. Shaefer UW, Beelen DW. Bone Harrow transplantation. 2nd ed. Germany: Karger; 1996:240
Travnik R, Beckers M, Wolff D, Holler E, Landthaler M, Karrer S. Graft-versus-Host Disease (GvHD) - an update : Part 1: Pathophysiology, clinical features and classification of GvHD. Hautarzt. 2011 Feb;62(2):139-54.
Brown RS, Edwards D, Walsh-Chocolaad T, Childs RW. Topical tacrolimus with custom trays in the treatment of severe oral chronic graft-versus-host disease refractory to a potent topical steroid therapy: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Apr;115(4):e26-30.
Noce CW, Gomes A, Shcaira V, Correa ME, Moreira MC, Silva Junior A, et al. Randomized double-blind clinical trial comparing clobetasol and dexamethasone for the topical treatment of symptomatic oral chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2014 Aug;20(8):1163-8.
Imanguli MM, Atkinson JC, Mitchell SA, Avila DN, Bishop RJ, Cowen EW, et al. Salivary gland involvement in chronic graft-versus-host disease: prevalence, clinical significance, and recommendations for evaluation. Biol Blood Marrow Transplant. 2010 Oct;16(10):1362-9.
Pavletic SZ, Martin P, Lee SJ, Mitchell S, Jacobsohn D, Cowen EW, et al. Measuring therapeutic response in chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. Response Criteria Working Group report. Biol Blood Marrow Transplant. 2006 Mar;12(3):252-66.
Pereira CM, de Almeida OP, Correa ME, Souza CA, Barjas-Castro ML. Oral involvement in chronic graft versus host disease: a prospective study of 19 Brazilian patients. Gen Dent. 2007 Jan-Feb;55(1):48-51.
Linhares YP, Pavletic S, Gale RP. Chronic GVHD: Where are we? Where do we want to be? Will immunomodulatory drugs help? Bone Marrow Transplant. 2013 Feb;48(2):203-9.
Salmasian H, Rohanizadegan M, Banihosseini S, Rahimi Darabad R, Rabbani-Anari M, Shakiba A, et al. Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplantation. Cochrane Database Syst Rev. 2010 Jan : 20(1):CD005565.
Imanguli MM, Pavletic SZ, Guadagnini JP, Brahim JS, Atkinson JC. Chronic graft versus host disease of oral mucosa: review of available therapies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Feb;101(2):175-83.
Arora M. Therapy of chronic graft-versus-host disease. Best Pract Res Clin Haematol. 2008 Jun;21(2):271-9.
Deodhar SD, Sethi R, Srimal RC. Preliminary study on antirheumatic activity of curcumin (diferuloyl methane). Indian J Med Res. 1980 Apr;71:632-4.
Satoskar RR, Shah SJ, Shenoy SG. Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. Int J Clin Pharmacol Ther Toxicol. 1986 Dec;24(12):651-4.
Mansourian A, Amanlou M, Shirazian S, Jahromi ZM, Amirian A. The effect of “Curcuma Longa” topical gel on radiation-induced oral mucositis in patients with head and neck cancer. IJRR. 2015 Jul;13(3):269-74.
Hatcher H, Planalp R, Cho J, Torti FM, Torti SV. Curcumin: from ancient medicine to current clinical trials. Cell Mol Life Sci. 2008 Jun;65(11):1631-52.
Lao CD, Ruffin MTt, Normolle D, Heath DD, Murray SI, Bailey JM, et al. Dose escalation of a curcuminoid formulation. BMC Complement Altern Med. 2006 Mar;6:10.
Clarkson M, Friedewald J, Eustace J, Rabb H. Acute kidney injury. Brenner & Rector’s The Kidney 8th ed Philadelphia, Pennsylvania, USA: Saunders, Elsevier. 2008:943-86.
Srimal RC, Dhawan BN. Pharmacology of diferuloyl methane (curcumin), a non-steroidal anti-inflammatory agent. J Pharm Pharmacol. 1973 Jun;25(6):447-52.
Kuhad A, Pilkhwal S, Sharma S, Tirkey N, Chopra K. Effect of curcumin on inflammation and oxidative stress in cisplatin-induced experimental nephrotoxicity. J Agric Food Chem. 2007 Dec;55(25):10150-5.
Awad AS, El-Sharif AA. Curcumin immune-mediated and anti-apoptotic mechanisms protect against renal ischemia/reperfusion and distant organ induced injuries. Int Immunopharmacol. 2011 Aug;11(8):992-6.
Shoskes DA. Effect of bioflavonoids quercetin and curcumin on ischemic renal injury: a new class of renoprotective agents. Transplantation. 1998 Jul;66(2):147-52.
Bayrak O, Uz E, Bayrak R, Turgut F, Atmaca AF, Sahin S, et al. Curcumin protects against ischemia/reperfusion injury in rat kidneys. World J Urol. 2008 Jun;26(3):285-91.
Sefidan AM, Mohajeri D. Preventive effects of turmeric (Curcuma longa Linn) on renal ischemia-reperfusion injury in rats. Adv Biores. 2013 Dec;4(4):40-6.
Ruby AJ, Kuttan G, Babu KD, Rajasekharan KN, Kuttan R. Anti-tumour and antioxidant activity of natural curcuminoids. Cancer Lett. 1995 Jul;94(1):79-83.
Ramsewak RS, DeWitt DL, Nair MG. Cytotoxicity, antioxidant and anti-inflammatory activities of curcumins I-III from Curcuma longa. Phytomedicine. 2000 Jul;7(4):303-8.
Elad S, Zeevi I, Or R, Resnick IB, Dray L, Shapira MY. Validation of the National Institutes of Health (NIH) scale for oral chronic graft-versus-host disease (cGVHD). Biol Blood Marrow Transplant. 2010 Jan;16(1):62-9.
Perez-Simon JA, Encinas C, Silva F, Arcos MJ, Diez-Campelo M, Sanchez-Guijo FM, et al. Prognostic factors of chronic graft-versus-host disease following allogeneic peripheral blood stem cell transplantation: the national institutes health scale plus the type of onset can predict survival rates and the duration of immunosuppressive therapy. Biol Blood Marrow Transplant. 2008 Oct;14(10):1163-71.
Cassileth BR, Deng G. Complementary and alternative therapies for cancer. Oncologist. 2004 Feb;9(1):80-9.
Singh S. From exotic spice to modern drug? Cell. 2007 Sep;130(5):765-8.
Ammon HP, Wahl MA. Pharmacology of Curcuma longa. Planta Med. 1991 Feb;57(1):1-7.
Shishodia S, Chaturvedi MM, Aggarwal BB. Role of curcumin in cancer therapy. Curr Probl Cancer. 2007 Jul-Aug;31(4):243-305.
Aggarwal BB, Sung B. Pharmacological basis for the role of curcumin in chronic diseases: an age-old spice with modern targets. Trends Pharmacol Sci. 2009 Feb;30(2):85-94.
Masuda T, Hidaka K, Shinohara A, Maekawa T, Takeda Y, Yamaguchi H. Chemical studies on antioxidant mechanism of curcuminoid: analysis of radical reaction products from curcumin. J Agric Food Chem. 1999 Jan;47(1):71-7.
Tirkey N, Kaur G, Vij G, Chopra K. Curcumin, a diferuloylmethane, attenuates cyclosporine-induced renal dysfunction and oxidative stress in rat kidneys. BMC Pharmacol. 2005 Oct;5:15.
Lin MT,Storer B,Martin PJ,Tseng LH,Gooley T,Chen PJ,Hansen JA. Relation of an interleukin-10 promoter polymorphism to graft-versus-host disease and survivalafter hematopoietic –cell transplantation.N Engl J Med.2003 Dec;349(23):2201-10.
Salmasian H, Rohanizadegan M, Banihosseini S, Rahimi Dara¬bad R, Rabbani-Anari M, Shakiba A, et al. Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GVHD) after allogenic stem cell transplantation. Cochrane Database Syst Rev. 2010 Jan;20:CD005565.
Gururaj AE, Belakavadi M, Venkatesh DA, Marme D, Salimath BP. Molecular mechanisms of anti-angiogenic effect of curcumin. Biochem Biophys Res Commun. 2002 Oct;297(4):934-42
Mohan R, Sivak J, Ashton P, Russo LA, Pham BQ, Kasahara N, et al. Curcuminoids inhibit the angiogenic response stimulated by fibroblast growth factor-2, including expression of matrix metalloproteinase gelatinase B. J Biol Chem. 2000 Apr;275(14):10405-12.
Yoysungnoen P, Wirachwong P, Bhattarakosol P, Niimi H, Patumraj S. Effects of curcumin on tumor angiogenesis and biomarkers, COX-2 and VEGF, in hepatocellular carcinoma cell-implanted nude mice. Clin Hemorheol Microcirc. 2006 Jan;34(1-2):109-15.