title: Comparison of the discontinuation rates and side-effect profiles of pilocarpine and cevimeline for xerostomia in primary Sjögren's syndrome.
abstract: OBJECTIVE
  There are currently no head-to-head comparisons of sialagogues for Primary Sjögren's syndrome (pSS). We compared the tolerability and side effect profile of pilocarpine and cevimeline in patients with pSS and determined clinical, laboratory and pathological variables associated with therapeutic failure.
  
  
  METHODS
  We retrospectively reviewed the use of pilocarpine and cevimeline in 118 patients with pSS who fulfilled the 2002 American European Consensus Group criteria in a University-based setting. Clinical, laboratory and pathological baseline variables were collected. Failure of therapy was defined as the clinician or patient's decision to stop treatment either due to lack of efficacy or side effects.
  
  
  RESULTS
  Cevimeline was associated with lower failure rates compared to pilocarpine among first-time users: 27% vs. 47% (p=0.02), and all users: 32% vs. 61% (p<0.001). Severe sweating was the most frequent side effect leading to cessation of therapy and occurred more frequently in pilocarpine (25%) than cevimeline (11%) users (p=0.02). Patients who previously failed one secretagogue were less likely to discontinue treatment with the other agent, 52% of first-time users vs. 27% of second-time users (p=0.004). Only ANA positivity was associated with failure: [59% vs. 38%] (p=0.03).
  
  
  CONCLUSIONS
  pSS patients were more likely to continue cevimeline than pilocarpine long-term due to fewer reported side effects with cevimeline. Therapeutic failure of one secretagogue did not predict similar results with the other since second time users were more likely to continue long-term treatment.
authors: Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. noaisehg@upmc.edu.
authors: Ghaith
authors: G
authors: Noaiseh
authors: Joshua F
authors: JF
authors: Baker
authors: Frederick B
authors: FB
authors: Vivino
mesh_terms: D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018721:Muscarinic Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D010862:Pilocarpine / Q000008:administration & dosage / Q000009:adverse effects*; D011812:Quinuclidines / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000150:complications* / Q000175:diagnosis; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D017211:Treatment Failure; D014987:Xerostomia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D018721:Muscarinic Agonists; D011812:Quinuclidines; D013876:Thiophenes; D010862:Pilocarpine; C059240:cevimeline