At present, there are no drug treatments approved by the FDA for Sjogren’s disease that address its root autoimmune causes. Management of systemic complications typically requires the use of immunomodulatory or immunosuppressive therapies for which there is wide experience or clinical trial validation in other systemic rheumatic diseases, such as rheumatoid arthritis or lupus.
Hydroxychloroquine is commonly used to manage inflammatory musculoskeletal pain, certain immune-mediated rashes, and fatigue in Sjogren’s.
Rituximab is used for specific systemic manifestations, including lymphoma, vasculitis with or without cryoglobulinemia, severe parotid swelling, inflammatory arthritis, pulmonary disease, peripheral neuropathy (especially mononeuritis multiplex) and for severe, refractory sicca manifestations when conventional therapies have proven insufficient.
A number of clinical trials have been conducted over the past decade testing therapies for Sjogren’s. Several of these clinical trials have shown promising results. These include trials testing iscalimab (an anti-CD40 monoclonal antibody) , ianalumab (a fully human anti-B-cell activating factor receptor monoclonal antibody), the combination of hydroxychloroquine and leflunomide, remibrutinib (a Bruton tyrosine kinase inhibitor), dazodalibep (a CD40 ligand inhibitor), and nipocalimab (a FcRN receptor blocker).
