Topical pilocarpine for xerostomia in patients with head and neck cancer treated with radiotherapy

Oral Dis. 2020 Apr 5. doi: 10.1111/odi.13343. Online ahead of print.

Abstract

Objective: To evaluate a pilocarpine spray as a treatment for xerostomia in patients treated with radiotherapy (RT) for head and neck cancer (HNC).

Methods: This was a placebo-controlled, double-blind, crossover clinical trial of patients complaining of dry mouth after RT for HNC. Forty patients were randomly assigned to either placebo or pilocarpine (1.54%) spray and instructed to use three times a day for 3 months. After 1-month washout period, patients were crossed over to receive placebo or pilocarpine. The assessments were salivary flow (Stimulated Whole Saliva Flow - SWSF), xerostomia (Xerostomia Inventory - XI), and quality of life (QoL/Oral Health Impact Profile - OHIP-14), assessed at baseline, 1 hr (only SWSF), and at 1, 2, and 3 months of treatment.

Results: Posttreatment SWFS was not statistically different between pilocarpine and placebo regardless of the treatment sequence (paired T test; p > .05), except for the SWFS rates at 2 months after therapy. When comparing pilocarpine with placebo in the time points, there was no significant difference (p > .05) for QoL or XI. Significant differences in improvement in QoL and xerostomia experience appeared along time for pilocarpine group.

Conclusion: The topical application of pilocarpine spray tested was similar to placebo on SWSF assessments in patients treated with RT for HNC.

Keywords: clinical trial; head and neck cancer; pilocarpine; quality of life; radiotherapy; xerostomia.