Topical Pilocarpine for Xerostomia in Patients with Head & Neck Cancer Treated with Radiotherapy
Pereira, R., Bastos, M., Ferreira, M. P., de Freitas, O., de Macedo, L. D., de Oliveira, H. F., Ricz, H., Motta, A., Macedo, A. P., Tirapelli, C., & Pedrazzi, V. (2020). PubMed.
Define any terms necessary:
What is this research about?
Methods/Methodology:
Results:
Possible questions to ask your doctor:
Reference: Pereira, R., Bastos, M., Ferreira, M. P., de Freitas, O., de Macedo, L. D., de Oliveira, H. F., Ricz, H., Motta, A., Macedo, A. P., Tirapelli, C., & Pedrazzi, V. (2020). Topical pilocarpine for xerostomia in patients with head and neck cancer treated with radiotherapy. Oral diseases. doi:10.1111/odi.13343
Summary written by Avery Singson; Edited by Wendy Liang
January 20th, 2020
Define any terms necessary:
- Pilocarpine: a medication commonly used to treat dry mouth
- Xerostomia: The effect of dry mouth resulting from hypofunction of the salivary gland due to causes such as radiotherapy for head & neck cancer treatment, xerogenic drug use, and systemic conditions.
What is this research about?
- Xerostomia has been proven to negatively impact quality of life as it can lead to dysphagia, dysgeusia, oral discomfort, problems with speaking, tooth decay and other gum diseases, teeth loss, oral infections, and issues with nutrition.
- Treatment of xerostomia remains an unresolved problem, however, recent academia suggests that pilocarpine - commonly studied for its salivary gland stimulating effects - is effective for controlling xerostomia.
- This study aimed to evaluate previous reports on the effectiveness of topical pilocarpine in high doses by examining the effects of pilocarpine spray on salivary flow, xerostomia, and quality of life of patients experiencing xerostomia due to radiotherapy for head and neck cancer.
Methods/Methodology:
- Forty patients were included in this study and were randomly divided into two groups with different treatment sequences: pilocarpine use followed by the placebo (sequence 1) and the placebo followed by pilocarpine (sequence 2). Both groups used the placebo and pilocarpine sprays three times a day for three months with a one-month wash-out period between each spray.
- The study assessed saliva volume and production rate using the stimulated whole saliva flow (SWSF) method, subjective xerostomia, and quality of life at baseline, one hour after treatment (SWSF only), and at one, two, and three months post-treatment.
Results:
- Analyzing the data using per protocol (PP) and intention-to-treat (ITT) analysis, there was no statistically significant difference found between pilocarpine and placebo use on post-treatment SWSF regardless of treatment sequence except for SWSF rates at two months of treatment under PP analysis.
- Subjective xerostomia inventory and reports on overall quality of life at each time point showed no significant differences between pilocarpine and placebo use.
- Discussion:
- SWSF was however found to increase at the individual level, leading to the conclusion that more research needs to be done on the cost-benefit considerations and efficacy of topical pilocarpine treatment.
- Despite finding that pilocarpine was not statistically better than the placebo in terms of overall quality of life and xerostomia, the parameters reportedly experienced statistically significant differences that were attributed to influence from external factors and patient profiles.
- Ultimately SWSF, quality of life experience, and xerostomia were not found to be different between pilocarpine and placebo treatments using PP and ITT analysis, regardless of sequence of treatments.
Possible questions to ask your doctor:
- What is the process for determining if pilocarpine is right for me?
- What are some adverse effects of topical pilocarpine?
- Do the benefits of pilocarpine outweigh the adverse effects of the drug in my case?
- If pilocarpine does work, how long will I have to be on it?
- If pilocarpine doesn’t work, what is the next step?
- If I don’t want to take pilocarpine, what are some other options?
- Is pilocarpine more effective if it is used in conjunction with another treatment?
- What are some research studies that you can direct me to on the efficacy of pilocarpine?
Reference: Pereira, R., Bastos, M., Ferreira, M. P., de Freitas, O., de Macedo, L. D., de Oliveira, H. F., Ricz, H., Motta, A., Macedo, A. P., Tirapelli, C., & Pedrazzi, V. (2020). Topical pilocarpine for xerostomia in patients with head and neck cancer treated with radiotherapy. Oral diseases. doi:10.1111/odi.13343
Summary written by Avery Singson; Edited by Wendy Liang
January 20th, 2020