MUCIN
Place in Therapy
Place in Therapy
Although available in places in Europe by the name of Saliva Orthana, animall mucin containing products for dry mouth are not currently available in Canada. However based on the aforementioned data (albeit, mostly primary literature with small sample size) it is effective, or atleast non-inferior to alternative saliva substitute agents for dry mouth currently on the Canadian market such as xanthan gum, polyacrylic acid and carboxymethylcellulose. Mucin also has data regarding reduction of complications of oral pathology and candidiases associated with dry mouth, thus broadening its role in patients suffering from dry mouth and its complications. Furthermore in the studies looking at mucin, no adverse effects were reported reflecting on its relative safety, atleast from small trials, many of which though had a sound design (randomized placebo-controlled, prospective). However given the animal origin of this product, bigger trials may need to be designed to confirm safety for widespread use. Some concerns around patient preference regarding mucin are also noted in one of the trials. This included an unpleasant taste of the bovine mucin despite the addition of a peppermint flavour to the final product. If mucin products are approved and available in Canada, manufacturers may have to pay special attention to the palatability of the final product.
Therefore, as a result of mostly primary literature available thus far, mucin appears as an equally effective if not more effective than currently available saliva substitutes for the use of dry mouth. Furthermore, studies have investigated mucin in several different patient populations such as Sogren’s, geriatrics, patients with radiotherapy as well as hospice patients, reflecting the versatility of this product in helping with dry mouth symptoms and complications in many different population types. Mucin appears to have great potential given the limited number of products available for the relief of dry mouth. Bigger, well designed trials can further confirm and shed light on this pharmacologic option. Since Mucin is already available on the internet and in Europe, North American markets including Canada will likely see it on the pharmacy shelves in a couple of years. Once its safety given the animal origin is assured, mucin can be an equally safe and effective option amongst the other saliva substitutes for the treatment of dry mouth. However, mucin products for dry mouth are only recommended for Canadians once they are available in the Canadian market having cleared safety and regulatory requirements.
References:
1. A.S Pharma: Saliva Orthana. Accessed July 5th 2013. Available at: http://www.aspharma.co.uk/products.htm
2. Bhxt-Johansen , G., Ek A.C, Ganowlak, W., Granerus, A-K., H. von Schenck, Unosson, M, Wiesel, K.. Improvement of oral mucosa with mucin containing artificial saliva in geriatric patients. Arch. Gerontol. Geriatr., 14 (1992) 193-201 193
3. Davies, A. A comparison of artificial saliva and chewing gum in the management of xerostomia in patients with advanced cancer. Palliative Medicine 2000; 14: 197–203
4. Fox, R., Creamer, P. Treatment of dry mouth and other non-ocular sicca symptoms in Sjögren's syndrome. In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2013.
5. Momm, F., Jurievna, N., Volegova-Neher1, Jürgen Schulte-Mönting, Guttenberger, R. Different Saliva Substitutes for Treatment of Xerostomia Following Radiotherapy. Strahlentherapie und Onkologie
6. North Bristol NHS Trust. Supportive Care for Renal Patients With Established Renal Failure (ERF): Information for GPs and the District Nurses. Accessed July 6th, 2013. Available at: http://www.nbt.nhs.uk/sites/default/files/filedepot/incoming/Supportive%20Care%20for%20Renal%20Patients%20with%20established%20renal%20failure.pdf
7. Sweeney, MP., Bagg, J., Baxter,WP., Paisley and Aitchison, T.C. Clinical trial of a mucin-containing oral spray for treatment of xerostomia in hospice patients.Palliative Medicine 1997; 11: 225-232.
8. Visch, L., Gravenmade, E.J., Schaub, H., Vanputten, WLJ., Vissink, A. A double-blind crossover trial of CMC- and mucin-containing saliva substitutes. lilt. J. Oral Maxillofac. SlIrg. 1986: 15: 395--400
9. Vander Reijden, W, Vander kwaak, M, Vissink, A , Veerman, E, and Amerongen, V.Treatment of xerostomia with patients with sjogren’s syndrome. ARTHRITIS & RHEUMATISM. Vol. 39, No. 1, January 1996, pp 57-6.
Although available in places in Europe by the name of Saliva Orthana, animall mucin containing products for dry mouth are not currently available in Canada. However based on the aforementioned data (albeit, mostly primary literature with small sample size) it is effective, or atleast non-inferior to alternative saliva substitute agents for dry mouth currently on the Canadian market such as xanthan gum, polyacrylic acid and carboxymethylcellulose. Mucin also has data regarding reduction of complications of oral pathology and candidiases associated with dry mouth, thus broadening its role in patients suffering from dry mouth and its complications. Furthermore in the studies looking at mucin, no adverse effects were reported reflecting on its relative safety, atleast from small trials, many of which though had a sound design (randomized placebo-controlled, prospective). However given the animal origin of this product, bigger trials may need to be designed to confirm safety for widespread use. Some concerns around patient preference regarding mucin are also noted in one of the trials. This included an unpleasant taste of the bovine mucin despite the addition of a peppermint flavour to the final product. If mucin products are approved and available in Canada, manufacturers may have to pay special attention to the palatability of the final product.
Therefore, as a result of mostly primary literature available thus far, mucin appears as an equally effective if not more effective than currently available saliva substitutes for the use of dry mouth. Furthermore, studies have investigated mucin in several different patient populations such as Sogren’s, geriatrics, patients with radiotherapy as well as hospice patients, reflecting the versatility of this product in helping with dry mouth symptoms and complications in many different population types. Mucin appears to have great potential given the limited number of products available for the relief of dry mouth. Bigger, well designed trials can further confirm and shed light on this pharmacologic option. Since Mucin is already available on the internet and in Europe, North American markets including Canada will likely see it on the pharmacy shelves in a couple of years. Once its safety given the animal origin is assured, mucin can be an equally safe and effective option amongst the other saliva substitutes for the treatment of dry mouth. However, mucin products for dry mouth are only recommended for Canadians once they are available in the Canadian market having cleared safety and regulatory requirements.
References:
1. A.S Pharma: Saliva Orthana. Accessed July 5th 2013. Available at: http://www.aspharma.co.uk/products.htm
2. Bhxt-Johansen , G., Ek A.C, Ganowlak, W., Granerus, A-K., H. von Schenck, Unosson, M, Wiesel, K.. Improvement of oral mucosa with mucin containing artificial saliva in geriatric patients. Arch. Gerontol. Geriatr., 14 (1992) 193-201 193
3. Davies, A. A comparison of artificial saliva and chewing gum in the management of xerostomia in patients with advanced cancer. Palliative Medicine 2000; 14: 197–203
4. Fox, R., Creamer, P. Treatment of dry mouth and other non-ocular sicca symptoms in Sjögren's syndrome. In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2013.
5. Momm, F., Jurievna, N., Volegova-Neher1, Jürgen Schulte-Mönting, Guttenberger, R. Different Saliva Substitutes for Treatment of Xerostomia Following Radiotherapy. Strahlentherapie und Onkologie
6. North Bristol NHS Trust. Supportive Care for Renal Patients With Established Renal Failure (ERF): Information for GPs and the District Nurses. Accessed July 6th, 2013. Available at: http://www.nbt.nhs.uk/sites/default/files/filedepot/incoming/Supportive%20Care%20for%20Renal%20Patients%20with%20established%20renal%20failure.pdf
7. Sweeney, MP., Bagg, J., Baxter,WP., Paisley and Aitchison, T.C. Clinical trial of a mucin-containing oral spray for treatment of xerostomia in hospice patients.Palliative Medicine 1997; 11: 225-232.
8. Visch, L., Gravenmade, E.J., Schaub, H., Vanputten, WLJ., Vissink, A. A double-blind crossover trial of CMC- and mucin-containing saliva substitutes. lilt. J. Oral Maxillofac. SlIrg. 1986: 15: 395--400
9. Vander Reijden, W, Vander kwaak, M, Vissink, A , Veerman, E, and Amerongen, V.Treatment of xerostomia with patients with sjogren’s syndrome. ARTHRITIS & RHEUMATISM. Vol. 39, No. 1, January 1996, pp 57-6.