Sjogren's syndrome: evolving therapies.

Area of Science:

• Immunology
• Ophthalmology
• Rheumatology

Background:

• Sjogren's syndrome (keratoconjunctivitis sicca) affects approximately 0.5% of adult women.
• Characterized by local (ocular, oral) and systemic manifestations.
• Recent FDA approvals for salivation-stimulating agents like pilocarpine and cevimeline.

Purpose of the Study:

• To review current and emerging therapies for Sjogren's syndrome.
• To evaluate the efficacy and safety of new treatments for ocular, oral, and systemic symptoms.
• To discuss the role of novel agents in managing Sjogren's syndrome.

Main Methods:

• Review of recent FDA-approved medications and ongoing clinical trials.
• Analysis of therapeutic agents for ocular manifestations, including topical cyclosporine A and purinogenic receptor agonists.
• Evaluation of oral therapies such as topical human interferon and alternative treatments like acid maltose lozenges.
• Discussion of systemic treatments, focusing on tumor necrosis factor inhibitors.

Main Results:

• Pilocarpine and cevimeline are FDA-approved for stimulating salivation.
• Topical cyclosporine A and purinogenic receptor agonists are under investigation for ocular symptoms.
• Topical human interferon shows encouraging short-term results for oral symptoms, though placebo and cheaper alternatives exist.
• Tumor necrosis factor inhibitors are being explored for systemic disease, but long-term cost-effectiveness and safety data are needed.

Conclusions:

• New therapeutic avenues are emerging for Sjogren's syndrome, addressing both local and systemic aspects.
• While promising, novel treatments require further evaluation for long-term efficacy, safety, and cost-effectiveness.
• Cheaper and safer alternatives may exist for managing oral symptoms, warranting consideration alongside newer therapies.