Efficacy of oral pilocarpine in patients with Sjøgren's syndrome

Abstract

Introduction A number of drugs have been tried for the relief of sicca symptoms in Sjøgren's syndrome (SS) without much benefit. Lately, oral pilocarpine, a muscarinic cholinergic agent, has been reported to be useful. Objective To document the effect of oral pilocarpine on sicca symptoms in patients with SS. Patients and Methods The study group comprised 41 patients (4 men and 37 women) diagnosed as SS (primary or secondary) according to European criteria. Patients were recruited from the rheumatology clinic, cornea clinic, and medicine OPD of AIIMS between April 2003 and March 2005. Study subjects received oral pilocarpine, 5 mg thrice a day for a total duration of 12 weeks. Assessment included measurement of salivary flow, Schirmer's test, Rose Bengal staining of cornea and slit lamp examination at 0, 6, and 12 weeks. Measurement of salivary flow and Schirmer's test was performed twice at every visit, pre-dose and post-dose. All the patients underwent subjective self-assessment of sicca symptoms on visual analogue scale (VAS). Statistical analysis was carried out using paired t-test and repeated measure analysis of variance. Results The mean age was 52.61 ±9.14 years. Mean duration of dry eye and dry mouth symptoms were 52.02 and 42.51 months, respectively. Treatment with pilocarpine was associated with a significant decrease in the VAS score for dry mouth and dry eye symptoms. Statistically significant increase in salivary flow rate was noticed after the first dose of pilocarpine and was maintained for 12 weeks. Rose Bengal score showed a significant improvement even though Schirmer's test result did not show improvement. The most common side effect was sweating. No serious side effect was noticed. Conclusions Treatment of sicca symptoms of SS with oral pilocarpine was found to be safe and efficacious.