Intra-lesional Corticosteroids Versus Platelet-Rich Plasma Versus Platelet-Rich Fibrin for the Treatment of Oral Lichen Planus: A Systematic Review and Network Meta-Analysis

Oral lichen planus (OLP) is a potentially malignant disorder affecting the oral mucosa. Platelet concentrates, including platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have emerged as promising alternative treatments to corticosteroids. This study aims to comprehensively evaluate the effectiveness of PRP and PRF in the management of patients with OLP. We conducted a comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) involving patients with OLP comparing intralesional PRP or PRF with corticosteroids up to August 2024. The primary outcomes assessed were changes in lesion size, pain scores, and Thongprasom scores. Network meta-analysis (NMA) was used. Data were pooled using summary effect sizes with corresponding 95% confidence intervals (CIs) in a random-effects model based on the DerSimonian-Laird method. Eight studies comprising 157 patients and 250 lesions were included in the final analysis. Compared to corticosteroids, no significant differences were observed among PRF and PRP in terms of changes in lesion size, pain scores, clinical severity scores, and adverse events. NMA ranking showed that PRF was the best-ranking treatment in reducing lesion sizes (SUCRA values: 72.6%, 75.8%, 66.2%, 80.8%, and 77.5% at first, second, third, fourth, and eighth weeks of assessment), followed by corticosteroids, and PRP. Moreover, PRF was the best-ranking treatment in reducing pain score at the first, third, and eighth weeks of assessment (SUCRA values: 91.8%, 86%, and 85.9%), while PRP was the best intervention at the second and fourth weeks of assessment (SUCRA values: 61.3%, and 90.2%). Also, PRF was the best intervention in terms of Thongprasom scores at eight weeks of assessment (SUCRA value: 77.3%), while PRP was the best intervention at the fourth week of assessment with value of 78.1%. PRF and PRP showed comparable results with intralesional corticosteroids in all studied parameters. Considering treatments ranking, PRF was the best intervention. The optimal treatment modality for OLP varies on different clinical conditions.