Efficacy and safety of traditional Chinese medicine combined with immunomodulators in treating erosive oral lichen planus: A network meta-analysis of randomized controlled trials

Background: This study aimed to systematically evaluate the efficacy and safety of various Chinese herbal medicines combined with immunomodulators (IMM) in the treatment of erosive oral lichen planus (EOLP) through a network meta-analysis. Methods: A total of 21 randomized controlled trials involving 1762 patients were included. Relevant randomized controlled trials were retrieved from 9 major electronic databases. All data were analyzed using a random-effects model. The surface under the cumulative ranking curve (SUCRA) was employed to rank the treatment regimens based on efficacy and clinical significance. To validate the robustness of the results, publication bias was assessed using funnel plots, and inconsistency tests were performed to compare direct and indirect effects. League tables were used to visualize comparative effects between treatments. Contribution plots were generated to evaluate the influence of individual treatments on the overall network effects. Statistical analyses were conducted using STATA 16.0 (StataCorp LLC, College Station), and study quality was assessed with Review Manager 5.4 (The Cochrane Collaboration, London, UK). Results: The combination of Kouyanqing granules and IMM (KYQ+IMM) demonstrated the highest efficacy in terms of response rate (SUCRA 82.7%) and pain relief (SUCRA 90.8%). Compound Danshen preparation combined with IMM (CDF+IMM) and Jiedu Yukou decoction combined with IMM (JDYK+IMM) ranked second and third, respectively. Total glucosides of peony showed the lowest recurrence risk (SUCRA 94.3%), while Kangfuxin solution combined with IMM (KFX+IMM) exhibited the most significant improvement in erosion area (SUCRA 86.4%). All treatment regimens were well-tolerated, with a low incidence of adverse events. Conclusion: This study demonstrates that integrated traditional Chinese and Western medicine regimens exhibit superior efficacy in improving response rates, pain relief, recurrence rates, and erosion healing in EOLP, with favorable safety profiles. Notably, KYQ+IMM, CDF+IMM, and KFX+IMM stand out as optimal therapeutic strategies, providing robust evidence for optimizing EOLP treatment.