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.

Reliable evidence for efficacy of single dose oral analgesics.

Data sourcesThe Cochrane library was searched for Cochrane systematic reviews.Study selectionCochrane reviews on single pain medications for the treatment of acute pain were included. Non-Cochrane reviews were included for tramadol.Data extraction and synthesisTwo reviewers independently searched, selected reviews for inclusion, assessed quality and performed data extraction. A protocol in case of disagreement was in place. Data were collected on number of included studies and participants, drug, dose and formulation and pain model. The authors concentrated on the amount of information and the potential for publication bias.Pain relief was calculated using at least 50% maximum pain relief, as a percentage, and as NNTs. Duration of analgesia was measured as mean or median and time to remedication was calculated as percentage of patients.ResultsThirty-nine reviews including 41 interventions were analysed and NNTs for at least 50% maximum pain relief were summarised in a graphic. NNTs range from almost one all the way to five. Only one intervention, codeine 60, had an NNT ≥10. Results judged to be reliable were listed in detail. Mean or median time to remedication was also presented in a graphic.The authors conclude that there is a great amount of quality information on single dose analgesics, and highlighted the potential benefit of fast acting formulations and fixed formulations to achieve good long-lasting analgesia.ConclusionsThere is a wealth of reliable evidence on the analgesic efficacy of single dose oral analgesics. Fast acting formulations and fixed dose combinations of analgesics can produce good and often long-lasting analgesia at relatively low doses. There is also important information on drugs for which there are no data, inadequate data, or where results are unreliable due to susceptibility to publication bias. This should inform choices by professionals and consumers.