Parasympathomimetic drugs for dry mouth due to radiotherapy.

Data sourcesCochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase and CINAHL databases. Reference lists of identified articles were checked and experts in the field and relevant pharmaceutical companies were contacted.Study selectionRandomised controlled trials, including parallel and crossover, carried out in any setting on any patient population with radiation-induced salivary dysfunction using parasympathomimetics drugs.Data extraction and synthesisThe two authors independently assessed for inclusion, established the risk of bias and abstracted data. The primary outcome was level of xerostomia. The authors intended to report risk ratio, odds ratio, risk difference and NNT for dichotomous data and mean difference and standard mean difference for continuous data.ResultsOf the three included studies, one (n=20) reported mean improvement on the VAS (22.5 mm on a 100 mm scale). The other two studies considered a change in 25 mm on the VAS a positive response. Of those one (n=207) reported positive response in 51% of subjects on 5mg of pilocapine TID and 47% for 10mg TID. The second (n= 162) reported a 42% positive response with a titrated dose regimen. The side effects rate was high,and the main reason for discontinuation.ConclusionsThere is limited evidence to support the use of pilocarpine hydrochloride in the treatment of radiation-induced xerostomia. Currently, there is little evidence to support the use of other parasympathomimetic drugs in the treatment of radiation-induced xerostomia. Available studies suggest that approximately half of patients will respond, but side effects can be problematic. The conclusions of the update are the same as the conclusions of the original review, since no new relevant studies have been published in the interim.

Oral cryotherapy reduced oral mucositis in patients having cancer treatments.

Data sourcesCochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CANCERLIT, CINAHL, the US National Institutes of Health Trials Registry and the WHO Clinical Trials Registry Platform.Study selectionRandomised controlled trials (RCTs) assessing the effects of oral cryotherapy in patients with cancer receiving treatment compared to usual care, no treatment or other interventions to prevent mucositis. The primary outcome was incidence of mucositis and its severity.Data extraction and synthesisTwo reviewers carried out study assessment and data extraction independently. Treatment effect for continuous data was calculated using mean values and standard deviations and expressed as mean difference (MD) and 95% confidence interval. Risk ratio (RR) was calculated for dichotomous data. Meta-analysis was performed.ResultsFourteen studies with 1280 participants were included. Subgroup analysis was undertaken according to the main cancer treatment type. Cryotherapy reduced the risk of developing mucositis by 39% (RR = 0.61; 95%CI, 0.52 to 0.72) on patients treated with fluorouracil (5FU). For melphalan-based treatment the risk of developing mucositis was reduced by 41% (RR =0.59; 95%CI, 0.35 to 1.01). Oral cryotherapy was shown to be safe, with very low rates of minor adverse effects, such as headaches, chills, numbness/taste disturbance and tooth pain. This appears to contribute to the high rates of compliance seen in the included studies.ConclusionsThere is confidence that oral cryotherapy leads to a large reduction in oral mucositis in adults treated with 5FU. Although there is less certainty on the size of the reduction on patients treated with melphalan, it is certain there is reduction of severe mucositis.