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Comparing the Effectiveness and Adverse Effects of Pilocarpine and Cevimeline in Patients with Hyposalivation.

OBJECTIVES
Pilocarpine(PILO) and cevimeline(CEV) are muscarinic acetylcholine-receptor agonists that stimulate salivary gland function. The aim of this investigation was to retrospectively run a head-to-head comparison for their effectiveness and frequency of adverse effects in patients with hyposalivation.


METHODS
A retrospective chart review was conducted for patients seen at the Oral Medicine Clinic at Tufts University School of Dental Medicine(TUSDM) and were prescribed PILO or CEV. Patients' demographics, medical history/medication, stimulated(SS) and unstimulated(US) salivary flow recorded at the initial visit and at 3 and 6-month follow-ups were collected. Changes in dosage/frequency, side effects, and drug discontinuation were also reported.


RESULTS
A total of 110 patients' charts were reviewed. Majority of subjects(91%) were females with an average age of 61. At 3-month follow-up, the use of CEV showed significant improvement in SS compared to PILO(P=0.033) but not in US(P=0.10). At 6-month follow-up, there was no significant difference in SS or US between the two groups(SS: P=0.09; US: P=0.71). The use of PILO was associated with a higher proportion of adverse effects compared to CEV(P=0.04). The overall adherence rate was significantly higher in the CEV group(P=0.0056).


CONCLUSION
The effectiveness of CEV and PILO is comparable. However, PILO seems to be associated with more reporting of side effects.