What do systematic reviews say?

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs Chlorhexidine mouthwash

Keratinocyte growth factor (KGF), intravenous led to lower oral mucositis (severe) compared with chlorhexidine mouthwash; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Children
  RR 0.01 [0.00, 0.19]
  1 study · 90 participants
  GRADE not reported

Pilocarpine vs no treatment/placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No evidence of a difference for any other adverse event (nausea, vomiting, chilling, headache, lacrimation, dysphasia, weakness, nervousness, rhinitis, blurred vision, urinary frequency, dizziness, palpitation, skin…
  Studies not reported
  GRADE not reported

Amifostine 200 mg/m2 three times weekly vs Amifostine 200 mg/m2 five times weekly

Amifostine 200 mg/m2 three times weekly showed no clear difference in nausea (adverse effect) compared with amifostine 200 mg/m2 five times weekly; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 0.64 [0.33, 1.25]
  1 study · 60 participants
  GRADE not reported

GM-CSF vs placebo or no treatment

Granulocyte-macrophage colony-stimulating factor (GM-CSF) led to lower number of days of treatment with opioid analgesics compared with placebo or no treatment; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  BMT/SCT after conditioning for haematological cancers
  MD -1.10 [-1.91, -0.29]
  1 study · 90 participants
  GRADE not reported

Amifostine 200 mg/m2 three times weekly vs Amifostine 200 mg/m2 five times weekly

Amifostine 200 mg/m2 three times weekly showed no clear difference in xerostomia (grade >= 2, 0-4 scale) compared with amifostine 200 mg/m2 five times weekly; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  12 months postRT
  RR 0.94 [0.58, 1.53]
  1 study · 49 participants
  GRADE not reported

Venalot Depot (coumarin plus troxerutin) vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No adverse events could be attributed to the experimental medication (Grotz 2001)
  1 study
  GRADE not reported

Selenium vs no intervention

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  6 weeks after end of RT
  23 serious adverse events in the selenium group versus 22 in the control group (P = 0.476); no significant differences in toxicities (Buntzel 2010)
  1 study
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Palifermin showed no clear difference in mouth and throat soreness (OMWQ-HN, 0-4 scale) compared with placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  3 months postRT
  MD -0.12 [-0.27, 0.02]
  2 studies
  GRADE not reported

Intestinal trefoil factor (ITF), lower dose (336 mg) vs Intestinal trefoil factor (ITF), higher dose (2688 mg)

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  Insufficient evidence to determine whether lower (336 mg) or higher (2688 mg) dose performs better (Analyses 11.1 to 11.3); no pooled estimate reported
  1 study · 66 participants
  GRADE not reported

Venalot Depot (coumarin plus troxerutin) vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RTOG scores were a composite of radiation side effects on different sites and could not be used for assessing xerostomia (Grotz 2001)
  1 study
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine may leads to higher nausea (adverse effect) compared with no treatment/placebo (low certainty).

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  RR 2.60 [1.81, 3.74]
  4 studies · 556 participants
  Low

Bethanechol vs Artificial saliva

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  Low rates of adverse effects (watering eyes, nervousness, frequent urination, sweating, warm face, cramps, diarrhoea, nausea) with insufficient evidence of any differences (Jham 2007)
  1 study
  GRADE not reported

Antimicrobial lozenge vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over 6 months
  Insufficient evidence of a difference for global quality of life, mouth pain RR 0.94 (95% CI 0.66 to 1.33), sore/burning mouth RR 0.95 (95% CI 0.68 to 1.35), throat pain RR 0.79 (95% CI 0.56 to 1.12) (Duncan 2005)
  1 study
  GRADE not reported

G‐CSF vs placebo or no treatment

It is very uncertain whether granulocyte-colony stimulating factor (G-CSF) changes oral mucositis (moderate to severe) compared with placebo or no treatment (very low certainty).

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Chemotherapy alone for breast cancer
  RR 0.33 [0.12, 0.95]
  1 study · 14 participants
  Very low

Erythropoietin mouthwash vs placebo

Erythropoietin mouthwash led to lower oral mucositis (any severity) compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes
  RR 0.35 [0.21, 0.60]
  1 study · 80 participants
  GRADE not reported

Epidermal growth factor (EGF), oral spray vs placebo

Epidermal growth factor (EGF), oral spray showed no clear difference in interruptions to cancer treatment (radiotherapy breaks longer than… compared with placebo; GRADE not reported.

• Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors 2017 · Cochrane All outcomes

  Radiotherapy to the head and neck
  RR 4.38 [0.25, 75.44]
  1 study · 113 participants
  GRADE not reported

Amifostine vs no treatment/placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT to 12 months postRT
  Insufficient evidence of a difference in stimulated salivary flow at any time point: end of RT MD -0.09 (95% CI -1.48 to 1.30); 3 months MD 0.38 (95% CI -1.43 to 2.19); 12 months MD 0.82 (95% CI -0.47 to 2.11);…
  2 studies
  GRADE not reported

Antimicrobial lozenge vs placebo

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  Over 6 months
  Insufficient evidence of a difference: dryness in mouth RR 1.18 (95% CI 0.97 to 1.42), diarrhoea RR 1.97 (95% CI 0.51 to 7.54), constipation RR 0.91 (95% CI 0.59 to 1.42) (Duncan 2005)
  1 study
  GRADE not reported

Antiseptic mouthrinse vs placebo

The review found no eligible studies for this question.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes
  No data on xerostomia were reported.
  0 studies
  No studies found

Pilocarpine vs no treatment/placebo

Pilocarpine led to higher speech difficulties (VAS 0-100 mm) compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  End of RT
  MD 20.20 [1.93, 38.47]
  1 study · 34 participants
  GRADE not reported