Bromhexine Treatment of Sjögren's Syndrome: Effect on Lacrimal and Salivary Secretion, and on Proteins in Tear Fluid and Saliva

Abstract

In a randomized clinical study, 32 patients with Sögren's syndrome (SS were given placebo/bromhexine (Bisolvon) 48 mg daily for 3 weeks. Various ophthalmological and oral variables as well as different proteins in the tear fluid and saliva were registered. Bromhexine stimulated the tear secretion significantly, presumable without changing the protein composition of the tear fluid. In contrast to other proteins in saliva the IgM concentration decreased in patients with high pre-treatment values. Bromhexine may be of valuable help in the treatment of some patients with SS.

Salivary Enhancement Therapies

“…However, there are no well-controlled studies which demonstrate that this agent will increase sali-Fox vary output or improve dry-mouth symptoms [FrostLarsen et al, 1978;Manthorpe et al, 1981;Prause et al, 1984]. There may be some benefit for dry-eye symptoms in Sjögren's syndrome [Tapper-Jones et al, 1980], but this has not been shown for the oral cavity.…”

Sjögren's Syndrome

“…Complete remission of symptoms from SS was observed in one patient with severe eye symptoms (32), and on this background two randomised clinical trials have been carried out (20,40). The results suggest a dose-related effect of bromhexine on lacrimal secretion in patients with SS.…”

“…The results suggest a dose-related effect of bromhexine on lacrimal secretion in patients with SS. The values for break-up time and Schirmer tests (20,40) as well as the corneal .sensitivity (40) all increased significantly during treatment with bromhexine. Also a decrease in salivary IgM concentration was observed (40).…”

“…The values for break-up time and Schirmer tests (20,40) as well as the corneal .sensitivity (40) all increased significantly during treatment with bromhexine. Also a decrease in salivary IgM concentration was observed (40). This supports data from open studies, where it has been shown that the concentration of salivary IgA and IgG may fall following bromhexine (50) -possibly due to an increased volume of saliva.…”

“…It is unknown at present why the lymphocytes accumulate in the salivary glands, to what extent the lymphocytes contribute to the tissue damage and to the synthesization and secretion of the different rheumatoid factors. It is noticeable that treatment of SS with either cyclophosphamide or bromhexine may reduce one or more of the immunoglobulins in saliva if they are present in large amounts (4,40,50).…”