BACKGROUND:Oral lichen planus (OLP) is an inflammatory disease involving the oral mucosa. It affects roughly 0.5% to 2% of the global population and has an associated risk of oral squamous cell carcinoma. Treatment of moderate to severe OLP often requires immunosuppression. The durability of immunosuppressive medication is currently unknown and is important for understanding therapeutic testing needs. OBJECTIVE:We investigated traditional immunosuppressive drug survival in patients with OLP and evaluated potential discontinuation factors. METHODS:We retrospectively analyzed patients with OLP treated with methotrexate, mycophenolate, azathioprine, or cyclosporine. Time to medication discontinuation was evaluated using the Kaplan-Meier estimator, and Cox proportional hazards regression was used to compare the risk of discontinuing a medication between medications and across patient demographic and disease factors. RESULTS:We identified 125 treatment periods with mycophenolate (n=58), methotrexate (n=34), azathioprine (n=19), or cyclosporine (n=14). Most patients had erosive disease (92%), and median time (IQR) to discontinuation due to adverse events or inefficacy was 9.43 months (6.51-16.1). Overall, only cyclosporine was associated with higher risk of discontinuation compared to methotrexate (hazard ratio [HR]: 2.94; 95% confidence interval [CI]: 1.32-6.45). There was no evidence for risk differences across age or sex for the overall cohort. Within individual medication groups, age was associated with a small increased risk of discontinuing mycophenolate (HR: 1.05; 95% CI: 1.00-1.10) and a small decreased risk in cyclosporine (HR=0.94, 95% CI: 0.89-0.99). Otherwise, no demographic factors were associated with discontinuation. Treatment success was reported 8 times. DISCUSSION:Immunosuppressive medications were frequently discontinued after short time periods, and few were discontinued due to success. These data highlight the need for better systemic therapy in OLP.
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