Early immunosuppressive, biological treatments may thwart systemic Sjögren’s

In study, no patient treated early progressed to systemic disease

Andrea Lobo, PhD avatar

by Andrea Lobo, PhD |

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Introducing immunosuppressive or biological therapies early in people with Sjögren’s syndrome may prevent its progression to a bodywide systemic condition, a study in France suggests.

“In our study, we can see that the introduction of [immunosuppressive agents] or biotherapy in systemic forms is only effective in around 50% of cases. When introduced before systematization, it seems to prevent the appearance of new manifestations,” the researchers wrote in “Treatment of non-systemic Sjögren’s syndrome: Potential prevention of systematization with immunosuppressant agent/biotherapy,” which was published in the Journal of Translational Autoimmunity.

Sjögren’s syndrome is a chronic autoimmune disease that primarily affects the glands that produce tears and saliva, causing symptoms like dryness in the eyes and mouth. Many patients have extra-glandular manifestations that affect other tissues and organs, including the joints, skin, lungs, kidneys, and nervous system.

According to the European Alliance of Associations for Rheumatology (EULAR), immunosuppressant agents or biological therapies have been recommended for patients with systemic involvement since 2019. However, for those with dry syndrome, general physical weakness, and joint pain, treatments focus mainly on alleviating symptoms.

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Early treatment prevents systemic involvement

Here, researchers evaluated the safety and benefit of immunosuppressant or biological therapies in people with Sjögren’s without systemic involvement who’d been followed at Grenoble University Hospital, France. A total of 83 patients were included, mainly women (88%), with a mean age of 56 at the time of their diagnosis and a mean disease duration of 11.3 years. Most (64) had nonsystemic disease at the start of follow-up, while 19 had systemic disease.

Among those who didn’t have systemic disease initially, 24 rapidly started treatment with immunosuppressant agents or biological therapies. Thirty patients received treatment with hydroxychloroquine, which is commonly used for pain and dryness.

Immunotherapy and biological treatments included mainly methotrexate (16 patients), abatacept (10), and rituximab (10).

None of the 24 patients treated with immunosuppressant agents or biological therapies progressed to systemic disease, but 11 of the 40 who didn’t receive these treatments did progress to systemic syndrome. Treatment with hydroxychloroquine alone didn’t prevent disease systematization.

Among those with systemic disease, 15 were treated with immunosuppressive or biological therapies, while four didn’t receive treatment. Of those who were untreated, one developed a new systemic disease manifestation.

Sixteen patients were treated with pilocarpine, a medication used for symptoms of dryness. Neither pilocarpine nor immunosuppressants or biological therapies could ease dryness, results showed.

“In our study, we found no reduction in the risk of dry syndrome complications,” the researchers wrote. “This raises the question of the value of [pilocarpine] as a long-term treatment, all the more so as it is often poorly tolerated.”

In general, immunosuppressive and biological therapies were well tolerated. The most frequent side effects were digestive issues on methotrexate and abatacept, and joint pain and general physical weakness after a course of rituximab. Two patients discontinued treatment due to infections.

“In conclusion, [Sjögren’s syndrome] is a chronic disease with the risk of immediate or secondary systematization. Immunosuppressive treatments or biotherapy might prevent secondary systematization, but further randomized studies are needed,” the researchers wrote.