Pilocarpine for Xerostomia and Xerophthalmia in Sjögren’s Syndrome: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

​Seven systematic reviews (three of which contained relevant primary studies) were identified regarding the clinical effectiveness of pilocarpine in the treatment of Sjögren’s syndrome-induced dry mouth and/or dry eyes. In addition, two evidence-based guidelines were identified regarding pilocarpine for the treatment of dry mouth and dry eyes in Sjögren’s syndrome. No evidence on the cost-effectiveness of pilocarpine for patients with Sjögren’s syndrome experiencing either dry mouth or dry eyes was identified.

Three systematic reviews of critically low quality contained three relevant primary studies which provided a limited quantity of evidence applicable to this report. The three primary studies provided heterogenous evidence as they had different patient populations, comparators and outcomes. Overall, pilocarpine was effective in the treatment of Sjögren’s syndrome-induced dry mouth and dry eyes but may not be as tolerable as cevimeline. 

Both guidelines recommend the use of pilocarpine for the treatment of dry mouth. One guideline also recommends pilocarpine for the treatment of dry eyes whilst the second guideline states it may be considered for the treatment of dry eyes.

Overall, the findings of this report come with a degree of uncertainty as the identified evidence was of critically low quality and quantity.