Anti-CD20 treatment in primary Sjögren's syndrome

We performed a search for publications on rituximab (Rtx) in the treatment of primary Sjögren's syndrome (pSS), and assessed the reports for the efficacy of the drug on complaints like sicca symptoms, systemic manifestations and pSS associated lymphoma. We also reviewed the effects on laboratory parameters and potential adverse effects. From the published literature there is little evidence supporting Rtx to have an effect on sicca symptoms, and there is particularly lack of objective improvements in measures of oral and ocular dryness. Systemic manifestations such as fatigue, synovitis, arthralgia, cryoglobulinaemia-related vasculitis, neurological, renal and pulmonary involvement all seem to react favourably to Rtx treatment. The effect on pSS associated non-Hodgkin's lymphoma is also beneficial. Rheumatoid factor concentration is decreasing during Rtx treatment. The levels of anti-SSA and -SSB antibodies are, however, unaltered according to the majority of the studies. The most common complications to Rtx treatment are mild and transient infusion related reactions. Delayed moderate-to-severe reactions are less common, and occur mostly in patients who develop human anti-chimeric antibodies. In conclusion, Rtx is a promising treatment option for severe pSS with systemic complications, but more data from randomized controlled trials are warranted before conclusions on the drug's role can be made with more accuracy.