Serrano-Robles José Gerardo, Pérez-Vázquez Ana Karen, Vera-Duarte Guillermo Raul, Navas Alejandro, Ramirez-Miranda Arturo, Graue-Hernandez Enrique O, Kahuam-López Nicolás
Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City 11520, Mexico.
Centro de Investigación en Ciencias de La Salud Anáhuac (CICSA), Facultad de Ciencias de La Salud, Universidad Anáhuac México, Campus Norte, Mexico City 52786, Mexico.
Int J Mol Sci. 2025 Aug 22;26(17):8113. doi: 10.3390/ijms26178113.
Dry eye disease (DED) is a prevalent and disabling condition. Artificial tears are commonly used but often inadequate for moderate-to-severe cases. Secretagogues such as pilocarpine, cevimeline, and diquafosol offer potential alternatives, though their comparative effectiveness remains unclear. To evaluate the safety and efficacy of these secretagogues versus artificial tears in adults with DED, we searched CENTRAL, PubMed, Scopus, LILACS, ClinicalTrials.gov, and WHO ICTRP without language restrictions. Randomized controlled trials (RCTs) comparing secretagogues to artificial tears were eligible. Data extraction and synthesis were conducted using Covidence and the Cochrane RoB 2 tool, and 19 RCTs (n = 2697) were included. Fifteen were analyzed quantitatively; however, only eight trials evaluating diquafosol were suitable for meta-analysis, as data for pilocarpine and cevimeline were insufficient for quantitative synthesis. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42020218407. Diquafosol significantly improved rose bengal staining at 4 weeks and OSDI scores and TBUT in post-cataract patients at 4 and 12 weeks. However, it increased mild adverse events (RR, 1.81; 95% CI, 1.15-2.84). Evidence for pilocarpine and cevimeline was limited. Diquafosol 3% shows greater efficacy than artificial tears in post-cataract DED but with more side effects. Further research is needed for other secretagogues.
干眼症（DED）是一种常见且使人致残的病症。人工泪液是常用药物，但对于中重度病例往往效果不佳。毛果芸香碱、西维美林和地夸磷索等促分泌剂提供了潜在的替代方案，不过它们的相对有效性仍不明确。为了评估这些促分泌剂与人工泪液相比在成年干眼症患者中的安全性和有效性，我们检索了CENTRAL、PubMed、Scopus、LILACS、ClinicalTrials.gov和世界卫生组织国际临床试验注册平台，无语言限制。比较促分泌剂与人工泪液的随机对照试验（RCT）符合纳入标准。使用Covidence和Cochrane RoB 2工具进行数据提取和综合分析，纳入了19项RCT（n = 2697）。1项进行了定量分析；然而，只有8项评估地夸磷索的试验适合进行荟萃分析，因为毛果芸香碱和西维美林的数据不足以进行定量综合分析。采用GRADE评估证据确定性。PROSPERO注册编号：CRD42020218407。地夸磷索在4周时显著改善了孟加拉玫瑰红染色，在白内障术后患者中，4周和12周时显著改善了眼表疾病指数（OSDI）评分和泪膜破裂时间（TBUT）。然而，它增加了轻度不良事件（RR，1.81；95%CI：1.15 - 2.84）。毛果芸香碱和西维美林的证据有限。3%的地夸磷索在白内障术后干眼症中比人工泪液疗效更佳，但副作用更多。其他促分泌剂还需要进一步研究。
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