Host modulation therapy
Host modulation therapy
Host modulation therapy has been proposed as an adjunct to conventional periodontal treatment.
Key recommendation
The use of host modulation therapy is not recommended for the routine care and management of patients with a diagnosis of periodontitis.
(Conditional recommendation; low certainty evidence)
Host modulation therapy uses local or systemic drugs as adjuncts to conventional periodontal treatment, with the aim of modifying the destructive aspects of the host inflammatory response to the microbial biofilm. One of the earliest and best known of these interventions utilises the anti-inflammatory properties of sub-antimicrobial dose doxycycline.
A review of evidence indicates that while host modulation therapy using sub-antimicrobial dose doxycycline may result in statistically significant improvements to patient outcomes compared to those achieved by PMPR alone, the clinical relevance of these improvements is less clear.79 The evidence is considered to be low certainty due to concerns about the methodology of some of the included studies, such as risk of bias and indirectness. There is currently no evidence that the low antibiotic doses utilised by this treatment regime are associated with the development of antibiotic resistance.80 However, host modulation therapy requires patients to take systemic medication over long periods of time (e.g. up to nine months) and this may impact on compliance. The cost effectiveness of the therapy is unclear and side effects related to liver enzymes have also been reported.
Given the unclear clinical benefits of the intervention and the potential risks associated with it, the BSP implementation of European S3 – level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice (BSP-S3)6 guideline does not suggest the use of systemic sub-antimicrobial doxycycline as an adjunct to subgingival instrumentation.
The use of other of host modulating therapies (statins, bisphosphonates, probiotics, non-steroidal anti-inflammatory drugs, Omega-3 polyunsaturated fatty acids, metformin) was not specifically examined during the development of this guidance. However, the BSP-S3 guideline does not recommend the use of these other host modulation therapies as an adjunct to subgingival instrumentation.
Further details on the development of the recommendations in this guidance can be found in Methodology.