Treatment of Sjögren syndrome

January 01, 0001

Treatment of Sjögren syndrome

No evidence-based guidelines are currently available for the treatment of Sjögren syndrome. These European and US researchers searched MEDLINE and EMBASE for articles on controlled trials of drug therapy for primary Sjögren syndrome published between 1986 and 2010. .

The researchers report: "The search strategy yielded 37 trials. A placebo-controlled trial found significant improvement in the Schirmer and corneal staining scores, blurred vision, and artificial tear use in patients treated with topical ocular 0.05% cyclosporine. Three placebo-controlled trials found that pilocarpine was associated with improvements in dry mouth (61%-70% vs 24%-31% in the placebo group) and dry eye (42%-53% vs 26%). Two placebo-controlled trials found that cevimeline was associated with improvement in dry mouth (66%-76% vs 35%-37% in the placebo group) and dry eye (39%-72% vs 24%-30%). Small trials (less than 20 patients) found no significant improvement in sicca outcomes for oral prednisone or hydroxychloroquine and limited benefits for immunosuppressive agents (azathioprine and cyclosporine). A large trial found limited benefits for oral interferon alfa-2a. Two placebo-controlled trials of infliximab and etanercept did not achieve the primary outcome (a composite visual analog scale measuring joint pain, fatigue, and dryness). Neither did 2 small trials (<30 patients) testing rituximab, although significant results were observed in some secondary outcomes and improvement compared with baseline."

The researchers concluded: "In primary Sjögren syndrome, evidence from controlled trials suggests benefits for pilocarpine and cevimeline for sicca features and topical cyclosporine for moderate or severe dry eye. Anti-tumor necrosis factor agents have not shown clinical efficacy, and larger controlled trials are needed to establish the efficacy of rituximab."

This systematic review provides a summary of evidence on topical and systemic therapy for Sjögren syndrome.

For the full abstract, click here.

JAMA 304(4):452-460, 28 July 2010
© 2010 American Medical Association
Treatment of Primary Sjogren Syndrome-A Systematic Review. Manuel Ramos-Casals, Athanasios G. Tzioufas, John H. Stone, Antoni Sisó, Xavier Bosch.

Category: A. General/Unspecified. Keywords: Sjogren Syndrome, sicca, cyclosporine, pilocarpine, rituximab, systematic review, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 17 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.