Manejo farmacológico e não farmacológico da xerostomia induzida por radioterapia: uma revisão sistemática seguida de metanálise em rede

Abstract

The aim of this systematic review followed by a network meta-analysis was to estimate the comparative effectiveness of available treatments for post-radiotherapy xerostomia. We included randomized clinical trials and used the Medline, Embase, Cochrane Library (CENTRAL), Cinahl and Scopus databases. Two independent reviewers performed study selection, data extraction and risk of bias assessment using the RoB 2.0 tool. For the assessment of the certainty of the evidence we use the Assessment, Development and Assessment Recommendations Ranking (GRADE) approach. We use the random effect model and Bayesian approach in network meta-analysis. We included in the systematic review 21 clinical trials, and, in the meta-analysis, we included 7 clinical trials, of which we had a total of 1,011 participants. As a result, after comparing the treatments, the interpretation of the forest plot allowed us to infer that systemic pilocarpine presents the best performance with a relative risk (RR) of 1.5 and a 95% credibility interval (Crl) of 0.93, 2.6. For analysis of salivary flow, we performed a conventional meta-analysis that showed us that pilocarpine tablet is more effective in increasing salivation compared to placebo (RR 1.39; 95% CI 1.06, 1.81). We also found that cevimeline used for 12 months causes a small increase in salivation (MD 0.04; 95% CI 0.02, 0.06).