Comparative efficacy of prevention strategies for oral mucositis in breast cancer patients: a network meta-analysis.

BACKGROUND

This study aimed to evaluate the efficacy of various interventions for preventing and alleviating oral mucositis (OM), a dose-limiting toxicity induced by cancer treatment.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from their inception to March 19, 2026. The quality of included studies was assessed using version 2 of the Cochrane risk-of-bias tool (ROB 2). A Bayesian network meta-analysis (NMA) was conducted utilizing R 4.5.1 and the JAGS package (version 4.3.1). The interventions were compared using league tables, surface under the cumulative ranking curve (SUCRA), and heterogeneity testing.

RESULTS

A total of 7,790 articles were retrieved. Ultimately, 10 randomized controlled trials (RCTs) involving 869 patients were included. According to the NMA, zinc most effectively reduced overall OM (RR = 0.53, 95%CrI: 0.27 to 0.95), while propolis dry extract was optimal for grade ≥ 2 OM (RR = 0.15, 95%CrI: 0.01 to 0.99). bifico significantly decreased overall OM (RR = 0.58, 95%CrI: 0.44 to 0.73) and ranked second for grade ≥ 2 OM. Subgroup analyses showed that professional oral health care and zinc were superior in chemotherapy patients, while MuGard and professional oral health care performed best in targeted therapy patients. Professional oral health care was most effective against grade ≥ 2 OM in the targeted therapy subgroup (SUCRA = 96.17%).

CONCLUSION

Zinc and propolis dry extract are the most optimal strategies for overall and grade ≥ 2 OM in BC patients, respectively. bifico shows promising clinical potential. Professional oral health care is effective in both chemotherapy and targeted therapy subgroups. Further large-scale RCTs are needed to validate these findings.

CLINICAL TRIAL NUMBER: Not applicable.