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Interventions for dry mouth and hyposalivation in Sjögren’s syndrome: A systematic review and meta‐analysis
Author(s) -
Al Hamad Arwa,
Lodi Giovanni,
Porter Stephen,
Fedele Stefano,
Mercadante Valeria
Publication year - 2019
Publication title -
oral diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.953
H-Index - 87
eISSN - 1601-0825
pISSN - 1354-523X
DOI - 10.1111/odi.12952
Subject(s) - medicine , dry mouth , placebo , pilocarpine , meta analysis , adverse effect , psychological intervention , rituximab , randomized controlled trial , saliva , pathology , alternative medicine , lymphoma , psychiatry , epilepsy
Objectives Systematic review with meta‐analysis of interventions for dry mouth symptoms and hyposalivation of Sjögren's syndrome (SS). Materials and Methods We searched MEDLINE, Cochrane Central and EMBASE up to February 2018 for randomized trials of interventions for dry mouth and hyposalivation of SS. The primary outcome was the mean change in xerostomia symptoms. The secondary outcomes included changes in salivary flow and quality of life. We used the Cochrane risk of bias tool for individual studies and the GRADE method to summarize the quality of evidence across studies for the included outcomes. Results Thirty‐six studies (3,274 patients) were included in the systematic review. Results from the meta‐analyses showed high‐quality evidence that pilocarpine was superior to placebo in reducing dry mouth symptoms. We found moderate quality of evidence that pilocarpine, rituximab and interferon‐alpha were more effective than placebo in increasing salivary flow, with the relevant effect size being large for pilocarpine, and notably smaller for rituximab and interferon‐alpha. Conclusion Clinicians should be very confident in the beneficial effects of pilocarpine upon dry mouth symptoms of SS and moderately confident that pilocarpine, rituximab and interferon‐alpha can have beneficial effects upon salivary flow. Adverse events are common. The use of other treatment modalities cannot be supported on the basis of current evidence.