Corticoids Reduce Incidence of Oral Mucositis during Antineoplastic Treatment? A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Clinical Trials

BACKGROUND: Oral mucositis (OM) is a serious complication of antineoplastic therapy and its clinical presentation can range from small erythematous lesions to large, debilitating ulcerative areas. This adverse effect results from the non-specificity of chemotherapeutic agents. This study aims to determine whether corticosteroid protocols reduce the incidence or severity of OM during antineoplastic treatment. MATERIALS AND METHODS: This PROSPERO registered systematic review (CRD42023442448) searched PubMed, Scopus, Web of Science, LILACS, EBSCOhost, LIVIVO, Embase, and the gray literature. RoB-2 and ROBINS-I were used to assess the risk of bias (RoB), and a meta-analysis was performed evaluating the incidence or severity of OM. GRADE-pro analyzed the certainty of the evidence. RESULTS: Of the 1795 articles, 5 RCTs and three n-RCTs were included, involving 718 patients, 255 men and 463 women distributed among 379 patients in the intervention groups and 339 patients in the control groups. High heterogeneity and low publication RoB were identified. The topical application of corticosteroids did not impair OM incidence (p=0.860). However, the systemic application of corticosteroids resulted in a reduction of 0.44 (CI95% = 0.29 to 0.66) times (p<0.001). There is no significant risk of publication bias (p=0.881). In the meta-analysis of OM severity, topical (p=0.280) or systemic (p=0.270) application did not show a significant reduction in the MO scores; there was no significant heterogeneity (p=0.940, I²=0%), and leave-one-out analysis demonstrated that removing individual study results did not alter this outcome. GRADE showed moderate certainty for both OM incidence and severity. Inconsistency and imprecision were low to moderate, and the risk of publication bias was low. CONCLUSION: High doses of systemic corticosteroids demonstrate clinical benefits in controlling OM, while the topical use requires further investigation, particularly with high-potency formulations.