Hydroxychloroquine vs. Clobetasol Rinse to Treat Oral Lichen Planus

• Status: Completed
• Trial end date: 2005-10-01
• Target enrollment: 0
• Participant gender: All

Summary

This study will compare two treatments for oral lichen planus - hydroxychloroquine (Plaquenil) tablets and clobetasol oral rinse. Oral lichen planus is a chronic disorder in which patients have painful mouth ulcers that interfere with meals and daily functioning. It is most commonly treated with topical or systemic corticosteroids, but these drugs have a number of side effects, most commonly yeast infection, and chronic systemic use of them can lead to diabetes, osteoporosis, weight gain, and other complications. Also, lichen planus generally returns when the corticosteroids are stopped. Clobetasol oral rinse is a topical steroid commonly used to treat oral lichen planus. Hydroxychloroquine, a drug that was originally used to treat malaria and is now also approved for lupus and rheumatoid arthritis, has been tried for lichen planus in small-scale studies with some evidence of benefit.

Patients 18 years of age and older with oral lichen planus may be eligible for this study. Pregnant women are excluded. Candidates are screened with a dermatology examination, routine blood tests, an eye examination, and a biopsy to rule out other conditions similar to lichen planus and to provide tissue for research purposes. For the biopsy, two small circles of tissue about 4 mm (less than 1/5") across are surgically removed from the area with lichen planus.

Participants are randomly assigned to treatment with either hydroxychloroquine or clobetasol rinse. Patients assigned to hydroxychloroquine also take a placebo mouth rinse that looks and tastes like the clobetasol rinse, and those assigned to clobetasol also take a pill that looks and tastes like the hydroxychloroquine tablet. This is done so that neither the patients nor the study doctors know which patient is taking which active medication until the study is completed. Patients take the pills daily in the morning with food or a glass of milk for the 6-month study period and use the rinse twice a day for 4 months and then once a day for 2 months. They may not use any pain or anti-inflammatory medicines or topical creams, gels or rinses regularly, because these medications can obscure the effects of the study drugs and complicate interpretation of the results. They are given a topical numbing medicine as part of the study and can use Tylenol for pain during the study duration.

In addition to treatment, participants visit the NIH Clinical Center once a month for the following tests and procedures:

• Review of pain levels, as recorded in a pain diary

• Review of drug side effects, if any

• Collection of saliva and blood samples at 2, 4 and 6 months

• Repeat oral biopsy at completion of the study at 6 months to evaluate treatment effects

• Final examination at 8 months to determine if the disease returns or improves after the medication is stopped.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Institute of Dental and Craniofacial Research (NIDCR)
• Treatments: Clobetasol; Hydroxychloroquine

Criteria

INCLUSION CRITERIA:

Biopsy confirmed symptomatic erosive oral lichen planus. World Health Organization histological criteria (21) in combination with compatible clinical picture will be used for diagnosis. In questionable cases, direct immunofluorescence will be performed to exclude other conditions.

No current treatment with hydroxychloroquine or other immunomodulatory agents. A one-month washout period will be required prior to enrollment if patients are taking immunomodulatory agents. Prior treatment with topical steroids will be allowed.

Age greater than 18 years old. Lichen planus is very rare in patients younger than 40 years old and children are especially sensitive to the effects of hydroxychloroquine.

Patients of both sexes and all racial and ethnic groups will be eligible.

The presence of at least one ulcerated oral lesion with a surface area of at least 100 sq. mm as measured bi-directionally.

EXCLUSION CRITERIA:

Unable to undergo oral biopsy for diagnosis

Lichen planus with no ulcerated oral lesions of greater than 100 sq. mm in area.

Treatment with hydroxychloroquine or other immunomodulatory agents within 1 month of the randomization.

Hepatitis B or Hepatitis C infection

Significant abnormalities in hepatic status as measured by liver function tests (ALT, AST, AP, bilirubin.) Mild asymptomatic elevations in liver enzymes (up to 20% above the reference range) will not preclude enrollment in the trial.

Significant abnormalities in renal status as measured by kidney function tests (creatinine, BUN).

Uncontrolled diabetes

Contraindications to hydroxychloroquine or clobetasol therapy (known hypersensitivity, retinopathy from prior use, history of aplastic anemia or agranulocytosis).

Anemia (defined as a hemoglobin level more than 2 standard deviations below the mean reference value for age).

Granulocytopenia (defined as an absolute neutrophil count (ANC) in adults as less than 1500/mm(3)).

Pregnancy or lactation. Pregnancy status will be assessed by questionnaire. Potentially pregnant patients will be evaluated by plasma HCG test. Patients planning pregnancy will be excluded. Sexually active females will be required to use contraception prior to enrollment in the study. Every woman of childbearing age will have a pregnancy test.

Inability or unwillingness to give written informed consent.

Serious concurrent disease (e.g. myocardial infarction, severe heart failure, severe COPD) requiring hospitalization or limiting life expectancy to less than 1 year.

Psoriasis

G6PD deficiency

Porphyria

Chronic use of non-steroidal anti-inflammatory agents or other agents to relieve pain.