Pilocarpine treatment of Sjögren's syndrome curative effect of meta-analysis of randomised controlled trials.

Abstract

Objectives: Recent research has increasingly focused on improving symptoms in patients with Sjögren's syndrome (SS). This study aims to evaluate the efficacy of oral pilocarpine in treating SS, synthesising the latest scientific evidence from randomised controlled trials (RCTs).

Methods: We systematically searched PubMed, Embase, the Cochrane Library, and the Science Citation Index for relevant randomised controlled trials (RCTs) published up to November 2023. Cochrane is used to assess the quality of literature studies and to extract data from included articles. The main results were summarised and analysed by Revman5.4.

Results: The meta-analysis included eight related RCTs involving 383 patients. All included studies were of moderate to high quality using the Cochrane Collaboration's tools for assessing the risk of bias.The results showed no significant improvement in Schirmer's test for the right [(RR 1.25, 95 % CI -0.68 to 3.18, heterogeneity I2=97%),] left eye (RR 5.15, 95%CI-1.73 to 12.02, heterogeneity I2=97%), right breakup time with fluorescein (RR 1.91, 95%CI -0.46 to 4.27, heterogeneity I2=89%) and left breakup time with fluorescein (RR 1.74, 95%CI -0.29 to 3.77, heterogeneity I2=87%) between ss and control groups. However, significant improvements were observed in the whole saliva test [(RR 0.20, 95%CI 0.09 to 0.30, heterogeneity I2=90%)], and Bijsterveld's score for both left (RR -4.18, 95%CI -7.14 to -1.21, I²=90%) and right eyes (RR -4.11, 95%CI -7.37 to -0.85, I²=92%), as well as in fluorescein 1% staining for the left (RR -0.81, 95%CI -1.26 to -0.36, I²=0%) and right eyes (RR -0.74, 95%CI -1.19 to -0.28, I²=0%).

Conclusions: Based on the current evidence, oral pilocarpine does not significantly improve Schirmer's test results or breakup time with fluorescein BUT in patients with SS. However, it does enhance outcomes in the Whole Saliva Test, Bijsterveld's score, and fluorescein 1% staining. These findings support the partial efficacy of pilocarpine in treating SS, with notable improvements in specific diagnostic measures. Further research is needed to fully understand the benefits of pilocarpine.