Effects of pilocarpine on salivary flow in patients with Sjo¨gren's syndrome

doi:10.1016/0030-4220(91)90491-T

Oral Surgery, Oral Medicine, Oral Pathology

Volume 72, Issue 5, November 1991, Pages 545-549

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(91)90491-T Get rights and content

Abstract

Pilocarpine, a muscarinic-cholinergic agonist drug, has been reported to stimulate salivary flow in patients with salivary gland dysfunction. Previous studies involved heterogenous groups of patients with salivary gland dysfunction and examined the short-term, single-dose, tablet form of pilocarpine. In this single-blind, placebo-controlled study we examined the long-term effects of pilocarpine administration on patients with definitively diagnosed Sjo¨gren's syndrome (SS). Nine subjects with SS who received pilocarpine, and nine age- and sex-matched SS control subjects who received a placebo, participated. Baseline predosing sialometric and clinical data were obtained for all subjects. The study group used 2% pilocarpine as a liquid ophthalmic drop preparation, four drops three times per day, for 6-weeks. Identically appearing placebo solution with the same dosing schedule and duration was used for the control subjects. Sialometric and clinical examinations were performed. The results indicated a significant overall increase in both whole unstimulated salivary flow (0.15 ± 0.03 ml/min in study subjects vs 0.02 ± 0.001 ml/min in control subjects;p < 0.001) and parotid stimulated salivary flow (0.14 ± 0.04 ml/min in study subjects vs 0.009 ± 0.002 ml/min in control subjects;p < 0.001) in the pilocarpine group as compared with the placebo group. The results of this study support the use of pilocarpine to increase salivary flow in patients with SS.

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On the other hand, late xerostomia is caused by gland fibrosis, is permanent and can occur up to one year after the radiation treatment [6,7]. Another cause of xerostomia is Sjögren Syndrome (SS), an autoimmune disease where the host immune cells target exocrine glands leading to hyposalivation [6,8,9]. Together, radiation therapy and SS cause loss in saliva quality and quantity that significantly decreases the quality of life of millions of patients.
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Exploratory study on reduction of the incidence of hyperhidrosis by oral pilocarpine
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Citation Excerpt :
Xerostomia associated with Sjögren's syndrome is treated effectively with cevimeline hydrochloride hydrate and oral pilocarpine [1–6].
An exploratory study on the effect of a low-dose divided dosing regimen of pilocarpine hydrochloride was performed to examine the effect of this regimen on reduction of the incidence of hyperhidrosis, an adverse effect of the drug. In the test regimen, the single dose was reduced and the dosing frequency was increased to 4 times a day.
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The incidence of Grade 2 or more severe hyperhidrosis was 10.0% (2 patients) in the test group and 40.0% (8 patients) in the control group, with no significant difference between the groups (p = 0.065). However, the low-dose divided dosing regimen significantly decreased the incidence of all grades of hyperhidrosis and significantly improved the saliva secretion rate and feeling of dry mouth compared to those before treatment.
The results suggest that the low-dose divided dosing regimen does not reduce the incidence of Grade 2 or more severe hyperhidrosis, but reduces the incidence of all grades of hyperhidrosis.
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Briefly, studies were assessed for risk of bias, inconsistency of the direction of results across studies, precision of effect estimates, use of surrogate outcomes (indirectness), and publication bias (available at: http://www.gradeworkinggroup.org/index.htm) (Table 2). Extensive literature has been published focusing on the effect of therapeutic interventions for the management of xerostomia and reduced salivary flow in SS: 43 studies included assessment of changes in perception of oral dryness or salivary flow1–3,7–46; 37 had sialometry as a primary or secondary outcome; 15 studies included randomization across groups in their study design (Table 3)1,14,16,17,19,20,24,26,27,30,31,36,37,39,45; and 5 studies included a crossover design with different washout periods.8,9,15,17,22 Additional study designs that addressed xerostomia or hypofunction were pilot short-term trials, safety trials, placebo-controlled (not randomized) trials, and quasiexperimental observational designs.
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Effects of pilocarpine on salivary flow in patients with Sjo¨gren's syndrome

Abstract

Arch Oral Biol

Labial salivary gland biopsy in Sjo¨gren's disease

J Clin Pathol

The oral component of Sjo¨gren's syndrome

J Oral Surg

Sjo¨gren's syndrome: newer aspects of research, diagnosis, and therapy

Ann Intern Med

Sjo¨gren's syndrome: current issues—part I

Ann Intern Med

Detection and management of the dental patient with Sjo¨gren's syndrome

Comp Cont Ed Dent