Biological therapies and management of oral mucosal disease

Biologic drugs are drugs made by living organisms and the term is usually limited to monoclonal antibodies or receptors targeting specific cytokines or cells that have been developed in recent decades. These drugs have had an enormous impact on the management of cancers, including head and neck cancers, and immune-mediated inflammatory conditions, for example, rheumatoid arthritis and inflammatory bowel disease. General dental practitioners will routinely be managing patients who are on these medications for a wide range of systemic conditions. These drugs also have a limited role in the management of immune-mediated oral mucosal disease. In this article, we will introduce the range of biological agents and their systemic indications and then elaborate on their use in oral mucosal disease and the disadvantages associated with their use. Key points General dental practitioners will increasingly manage patients on biologic therapy for a wide range of systemic indications. This paper is a useful introduction to these biological therapies. Biologic therapy has a limited role in the management of recalcitrant immune-mediated oral mucosal disease, in which the use of most of these agents is off-label. The most convincing evidence for their use in oral disease relates to rituximab, a B-cell inhibitor, which is licenced for use in pemphigus vulgaris and is now a first-line agent in the management of this disease.