Efficacy of tumour necrosis factor‐α antagonists in aphthous ulceration: review of published individual patient data

Background  Severe aphthous ulceration may require systemic immunosuppressive or immunomodulatory therapy, but a small subset of patients remains resistant to or intolerant of these agents. Although use of TNF‐α antagonists in aphthous ulceration is increasingly reported, the current evidence base for use is weak and evaluation of individual cases may provide the best available data to support such use. Objectives  The aim of this study was to review all published data on the use of TNF‐α antagonists in patients with severe aphthous ulceration refractory to systemic agents and discusses this in the context of any possible benefits that may guide any future use. Methods  A comprehensive search on MEDLINE and EMBASE from 1995 to 2010 was performed using pre‐defined search terms, with articles included if they met specific criteria. Results  Sixteen cases from individual case reports or small case‐series in which use of TNF‐α antagonists in aphthous ulceration were identified in which details of previous systemic therapy and use of subsequent adjunctive therapy were available. Agents with reported success in resolving active ulceration and reducing ulcer recurrence were infliximab, etanercept and adalimumab. Conclusions  Evidence for efficacy of TNF‐α antagonists in aphthous ulceration infection is limited. Such data suggest that in patients with severe aphthous ulceration TNF‐α antagonists have some efficacy in inducing ulcer resolution and reducing recurrence. These agents may represent an option in severe refractory aphthosis, although in the absence of controlled studies, caution is advocated if use is to be considered.