Colchicine in the Management of Oral Submucous Fibrosis - A Systematic Review and GRADE Assessment

Overview

Journal J Pharm Bioallied Sci

Specialty Pharmacology

Date 2025 Mar 10

PMID 40061634

Authors

Naveenaa Chellapandian

Vandana Sekizhar

Pavithranand Ammayappan

Kumar Chandan Srivastava

Ahmed Ismail Abdelrahman Nagy

Shivashankar Kengadaran

Artak Heboyan

Deepti Shrivastava

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Oral submucous fibrosis (OSMF) is a chronic oral potentially malignant disorder affecting the oral mucosa. The habit of areca nut chewing is established to be the causative factor. Various treatment modalities are available for managing OSMF. Colchicine obtained from plants of the genus can downregulate collagen synthesis and upregulate collagenolytic activity, thereby establishing its antifibrotic property. Hence, the objective of the current study is to assess the efficacy of colchicine in the treatment of OSMF.

Methods: A comprehensive search was conducted in MEDLINE via PubMed, Cochrane, ProQuest, Ovid, and Google Scholar, and the clinical trials evaluating the efficacy of oral colchicine for the treatment of OSMF were included. The Cochrane risk of bias tool and GRADE were utilized for assessing the quality.

Results: Three clinical trials (one randomized and two non-randomized trials) comprising 110 OSMF patients followed the eligibility criteria. The follow-up time for the patients was between 3 and 6 months. Mouth opening and burning sensation were the primary outcomes of interest. The risk of bias was found to be high in the studies included. GRADE quality assessment showed moderate quality for one study and two studies to be of low-quality evidence.

Conclusion: This review suggests that oral colchicine is efficacious in the management of OSMF and more distinctly in improving mouth opening. Considering the significant side effects from conventional treatment for OSMF, colchicine can be an effective modality in improving burning sensation and mouth opening in patients with OSMF.

References

Leung Y, Hui L, Kraus V . Colchicine--Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015; 45(3):341-50. PMC: 4656054. DOI: 10.1016/j.semarthrit.2015.06.013. View

Gopinath D, Hui L, Veettil S, Nair A, Maharajan M . Comparative Efficacy of Interventions for the Management of Oral Submucous Fibrosis: A Systematic Review and Network Meta-Analysis. J Pers Med. 2022; 12(8). PMC: 9409832. DOI: 10.3390/jpm12081272. View

Arakeri G, Patil S, Aljabab A, Lin K, Merkx M, Gao S . Oral submucous fibrosis: An update on pathophysiology of malignant transformation. J Oral Pathol Med. 2017; 46(6):413-417. DOI: 10.1111/jop.12582. View

Daga D, Singh R, Pal U, Gurung T, Gangwar S . Efficacy of oral colchicine with intralesional hyaluronidase or triamcinolone acetonide in the Grade II oral submucous fibrosis. Natl J Maxillofac Surg. 2017; 8(1):50-54. PMC: 5512409. DOI: 10.4103/njms.NJMS_5_17. View

FONTES V, Machet L, Huttenberger B, Lorette G, Vaillant L . [Recurrent aphthous stomatitis: treatment with colchicine. An open trial of 54 cases]. Ann Dermatol Venereol. 2003; 129(12):1365-9. View

Murti P, Bhonsle R, Gupta P, Daftary D, PINDBORG J, MEHTA F . Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing. J Oral Pathol Med. 1995; 24(4):145-52. DOI: 10.1111/j.1600-0714.1995.tb01156.x. View

Dasgeb B, Kornreich D, McGuinn K, Okon L, Brownell I, Sackett D . Colchicine: an ancient drug with novel applications. Br J Dermatol. 2017; 178(2):350-356. PMC: 5812812. DOI: 10.1111/bjd.15896. View

Rai A, Kumar A, Shree P, Haque Z, Kumari S, Yadav S . Colchicine in the Management of Oral Submucous Fibrosis: A Systematic Review, Meta-analysis, and GRADE-Based Assessment of Certainty of Evidence. Indian J Otolaryngol Head Neck Surg. 2023; 75(4):4125-4136. PMC: 10646101. DOI: 10.1007/s12070-023-03876-1. View

More C, Rao N . Proposed clinical definition for oral submucous fibrosis. J Oral Biol Craniofac Res. 2019; 9(4):311-314. PMC: 6614531. DOI: 10.1016/j.jobcr.2019.06.016. View

10.

Balshem H, Helfand M, Schunemann H, Oxman A, Kunz R, Brozek J . GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011; 64(4):401-6. DOI: 10.1016/j.jclinepi.2010.07.015. View

11.

Murthy V, Mylonas P, Carey B, Yogarajah S, Farnell D, Addison O . Malignant Transformation Rate of Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis. J Clin Med. 2022; 11(7). PMC: 8999767. DOI: 10.3390/jcm11071793. View

12.

Li J, Yao M, Zhu X, Li Q, He J, Chen L . YAP-Induced Endothelial-Mesenchymal Transition in Oral Submucous Fibrosis. J Dent Res. 2019; 98(8):920-929. DOI: 10.1177/0022034519851804. View

13.

Liu J, Chen F, Wei Z, Qiu M, Li Z, Dan H . Evaluating the efficacy of pentoxifylline in the treatment of oral submucous fibrosis: A meta-analysis. Oral Dis. 2017; 24(5):706-716. DOI: 10.1111/odi.12715. View

14.

Hsieh Y, Wu K, Chen H, Deng Y . Arecoline activates latent transforming growth factor β1 via mitochondrial reactive oxygen species in buccal fibroblasts: Suppression by epigallocatechin-3-gallate. J Formos Med Assoc. 2017; 117(6):527-534. DOI: 10.1016/j.jfma.2017.07.003. View

15.

Toader M, Esanu I, Taranu T, Mocanu M, Toader S . Colchicine in the treatment of refractory aphthous ulcerations: Review of the literature and two case reports. Exp Ther Med. 2021; 21(3):281. PMC: 7851653. DOI: 10.3892/etm.2021.9712. View

16.

Al-Maweri S, Ashraf S, Lingam A, Alqutaibi A, Abdulrab S, Alaizari N . Aloe vera in treatment of oral submucous fibrosis: A systematic review and meta-analysis. J Oral Pathol Med. 2018; 48(2):99-107. DOI: 10.1111/jop.12789. View

17.

Kumar M, Radhika B, Gollamudi N, Reddy S, Yaga U . Hyperbaric Oxygen Therapy-A Novel Treatment Modality in Oral Submucous Fibrosis: A Review. J Clin Diagn Res. 2015; 9(5):ZE01-4. PMC: 4484182. DOI: 10.7860/JCDR/2015/11500.5905. View

18.

Bari S, Metgud R, Vyas Z, Tak A . An update on studies on etiological factors, disease progression, and malignant transformation in oral submucous fibrosis. J Cancer Res Ther. 2017; 13(3):399-405. DOI: 10.4103/0973-1482.179524. View

19.

Almuzaien M, Mustafa A, Awais D, Alrasheed M, Awad M, Srivastava K . Awareness of Oral Submucous Fibrosis among the Quid-Chewing South-Asian Expatriates in the United Arab Emirates. J Pharm Bioallied Sci. 2024; 16(Suppl 2):S1461-S1464. PMC: 11174241. DOI: 10.4103/jpbs.jpbs_966_23. View

20.

More C, Patil D, Rao N . Medicinal management of oral submucous fibrosis in the past decade- A systematic review. J Oral Biol Craniofac Res. 2020; 10(4):552-568. PMC: 7479289. DOI: 10.1016/j.jobcr.2020.08.004. View