PMID- 31058469
OWN - NLM
STAT- MEDLINE
DCOM- 20201002
LR  - 20201002
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 72
IP  - 7
DP  - 2020 Jul
TI  - Meta-Analysis of Treatment for Primary Sjogren's Syndrome.
PG  - 1011-1021
LID - 10.1002/acr.23917 [doi]
AB  - OBJECTIVE: The current focus of treatment in primary Sjogren's syndrome (SS) is 
      symptom management. Since SS is an autoimmune disease with multisystem 
      involvement, systemic immunosuppression may have a role in improving signs and 
      symptoms and preventing progression. We undertook this review to assess the 
      efficacy and safety of immunomodulation on primary SS from randomized clinical 
      trials (RCTs). METHODS: Five electronic databases (Medline, Embase, Central, 
      ClinicalTrials.gov, and the World Health Organization International Clinical 
      Trials Registry Platform) were searched to include RCTs for the treatment of SS. 
      Primary outcome measures included ocular dryness, oral dryness, tear production, 
      and salivary function. Serious adverse events (AEs) and withdrawals due to AEs 
      were also assessed. RESULTS: The search yielded 32 trials evaluating 19 different 
      medications. The average duration of diagnosis was long (up to 9.2 years). 
      Twenty-two trials examined ocular and oral dryness, for which only 2 and 4 trials 
      showed statistically significant improvements, respectively. No studies found a 
      benefit for tear production; few studies found improvements for unstimulated 
      salivary flow (3 of 16 RCTs) and stimulated salivary flow (2 of 14 RCTs). 
      Meta-analysis at 6 months found improvements as compared to placebo for 
      unstimulated salivary flow (P = 0.003) and a decrease in the erythrocyte 
      sedimentation rate (P = 0.007). No differences were seen for serious AEs, but 
      there were increased withdrawals from AEs (risk ratio 2.33; P = 0.03). 
      CONCLUSION: Reducing inflammation potentially improves salivary gland function. 
      No individual immunomodulatory drug demonstrated a consistent benefit in 
      xerostomia and xerophthalmia. Further work is needed to identify SS patients with 
      an ability to improve and with outcomes that are valid and sensitive to change 
      within clinical trials. Tradeoffs in the future between benefit and safety may 
      also be important, because more withdrawals occurred with active treatment.
CI  - (c) 2019, American College of Rheumatology.
FAU - Chu, Lucy L
AU  - Chu LL
AD  - Schulich School of Medicine and Dentistry, Western University, London, Ontario, 
      Canada.
FAU - Cui, Kangping
AU  - Cui K
AD  - Schulich School of Medicine and Dentistry, Western University, London, Ontario, 
      Canada.
FAU - Pope, Janet E
AU  - Pope JE
AUID- ORCID: 0000-0003-1479-5302
AD  - Schulich School of Medicine and Dentistry, Western University, and St. Joseph's 
      Health Care, London, Ontario, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20200607
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Humans
MH  - Immunomodulation
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Sjogren's Syndrome/complications/*drug therapy
MH  - Treatment Outcome
MH  - Xerophthalmia/drug therapy/etiology
MH  - Xerostomia/drug therapy/etiology
EDAT- 2019/05/07 06:00
MHDA- 2020/10/03 06:00
CRDT- 2019/05/07 06:00
PHST- 2018/12/26 00:00 [received]
PHST- 2019/04/30 00:00 [accepted]
PHST- 2019/05/07 06:00 [pubmed]
PHST- 2020/10/03 06:00 [medline]
PHST- 2019/05/07 06:00 [entrez]
AID - 10.1002/acr.23917 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2020 Jul;72(7):1011-1021. doi: 10.1002/acr.23917. 
      Epub 2020 Jun 7.