Sjogren Syndrome Medication

Updated: Nov 18, 2017
  • Author: Anne V Miller, MD; Chief Editor: Herbert S Diamond, MD  more...
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Medication

Medication Summary

Most patients with Sjögren syndrome can be cared for adequately with topical therapy and with avoidance of medications that exacerbate their symptoms. Pilocarpine or cevimeline can be used in cases of xerostomia for which systemic therapy is needed or local therapy is not successful.

Rituximab has shown promise in the treatment of patients with severe extraglandular manifestations of Sjögren syndrome, such as vasculitis, cryoglobulinemia, and peripheral neuropathy. [82, 83] Although some data support its efficacy for glandular involvement, it is not currently used for treatment of sicca symptoms alone.

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Gastrointestinal Agents, Other

Class Summary

These agents bind to cholinergic (muscarinic) receptors, increasing the secretion of exocrine glands, including salivary glands.

Pilocarpine (Salagen)

Pilocarpine is a cholinergic parasympathomimetic agent that can be used to enhance secretion by exocrine glands when systemic therapy is needed or local therapy fails.

Artificial saliva

These preparations typically contain methylcellulose, sorbitol, and salts to moisten and lubricate the mouth.

Cevimeline (Evoxac)

Cevimeline is indicated for xerostomia in Sjögren syndrome.

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Ophthalmic Lubricants

Class Summary

Various over-the-counter (OTC) preparations of natural tears that provide topical therapy for dry eyes are available. Encourage patients to try different preparations to determine which works best for them.

Artificial tears (Nu-Tears, Murine Tears, Refresh, Tears Naturale)

These preparations contain the equivalent of 0.9% sodium chloride and are used to maintain ocular tonicity. They replace the aqueous layer of tears that is lost in patients with Sjögren syndrome. Preparations that have hydroxymethylcellulose or dextran are more viscous and therefore can last longer before reapplication is needed.

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Antimalarials

Class Summary

These agents are used to treat Sjögren syndrome ̶ associated arthritis that is unresponsive to NSAIDs.

Hydroxychloroquine (Plaquenil)

Hydroxychloroquine is an antimalarial agent. Its mechanism of action in inflammatory arthritis is unknown.

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Antineoplastics, Alkylating

Class Summary

Consider these agents in patients with Sjögren syndrome who develop a major organ manifestation such as interstitial lung disease.

Cyclophosphamide (Cytoxan)

Cyclophosphamide is an alkylating agent with potent immunosuppressant properties. Dosage adjustments should be based on monitoring clinical response and the CBC or nadir CBC.

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Immunomodulators

Class Summary

These agents may regulate key immune factors responsible for inflammation.

Cyclosporine ophthalmic (Restasis)

Cyclosporine ophthalmic is used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. It is thought to act as a partial immunomodulator, but the exact mechanism of action is not known.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Prednisone

Prednisone is an immunosuppressant used in the treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear cell activity. Prednisone stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production and activity.

Methylprednisolone (A-Methapred, Solu-Medrol, Depo-Medrol)

Methylprednisolone is available in intravenous (IV)/intramuscular (IM) or oral (PO) form. Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity.

Prednisolone (Pediapred, Prelone, Orapred)

Prednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity. It is a commonly used oral agent.

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Antineoplastics, Monoclonal Antibody

Class Summary

Rituximab has a promising effect in the treatment of patients with severe extraglandular manifestations of Sjögren syndrome. Although some data support its efficacy for glandular involvement, it is not currently used for the treatment of sicca symptoms alone. Rituximab has an off-label indication for Sjögren syndrome.

Rituximab (Rituxan)

Rituximab is a monoclonal antibody directed against the CD20 antigen on maturing B-lymphocytes, leading to the depletion of mature circulating B-cells, which are believed to play an important role in the pathophysiology of primary Sjögren syndrome.

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