Document Detail


Primary Sjögren syndrome: an update on current pharmacotherapy options and future directions.
MedLine Citation:
PMID:  23346917     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Primary Sjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by sicca features and systemic manifestations, and requires a multidisciplinary therapeutic approach.
AREAS COVERED: Treatment of sicca manifestations is symptomatic and is based on the administration of topical therapies (saliva substitutes and preservative-free artificial tears). In severe cases of keratoconjunctivitis sicca, topical cyclosporine A may be used. For patients with residual salivary gland function, stimulation of salivary flow with a sialogogue (pilocarpine or cevimeline) is the treatment of choice. The management of extraglandular features must be tailored to the specific organ(s) involved. Hydroxychloroquine may be appropriate for patients with fatigue, arthralgia and myalgia, while glucocorticoids and immunosuppressive agents should be reserved for severe systemic involvement (although no controlled trials in primary SS guide their use). RCTs have demonstrated the lack of efficacy of antitumor necrosis factor agents and promising results for B-cell depleting agents.
EXPERT OPINION: The overall low level of evidence in therapeutic studies in primary SS suggests that much larger trials of the most promising therapies are necessary. The use of drugs targeting molecules and receptors involved in the etiopathogenesis of primary SS may open up a new era in the therapeutic management of the disease, but the potential risks and benefits of these agents must be weighed carefully.
Authors:
Pilar Brito-Zerón; Antoni Sisó-Almirall; Albert Bové; Belchin A Kostov; Manuel Ramos-Casals
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-25
Journal Detail:
Title:  Expert opinion on pharmacotherapy     Volume:  14     ISSN:  1744-7666     ISO Abbreviation:  Expert Opin Pharmacother     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-04     Completed Date:  2013-07-22     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  100897346     Medline TA:  Expert Opin Pharmacother     Country:  England    
Other Details:
Languages:  eng     Pagination:  279-89     Citation Subset:  IM    
Affiliation:
Servei de Malalties Autoimmunes, Hospital Clínic, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Cyclosporine / therapeutic use
Glucocorticoids / therapeutic use
Humans
Hydroxychloroquine / therapeutic use
Immunosuppressive Agents / therapeutic use
Keratoconjunctivitis Sicca / drug therapy*,  physiopathology
Molecular Targeted Therapy*
Ophthalmic Solutions / therapeutic use
Saliva, Artificial / therapeutic use
Sjogren's Syndrome / drug therapy*,  physiopathology
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Immunosuppressive Agents; 0/Ophthalmic Solutions; 0/Saliva, Artificial; 118-42-3/Hydroxychloroquine; 59865-13-3/Cyclosporine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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