SP0190 2019 EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF SJöGREN”S SYNDROME WITH TOPICAL AND SYSTEMIC THERAPIES
Authors: Manuel Ramos-Casals, Pilar Brito-Zerón, Stefano Bombardieri, Hendrika Bootsma, Salvatore De Vita, Thomas Dörner, Benjamin A. Fisher, Jacques-Eric Gottenberg, Gabriela Hernández-Molina, Agnes Kocher, Belchin Kostov, Aike A. Kruize, Thomas Mandl, Wan-Fai Ng, Soledad Retamozo, Raphaèle Seror, Yehuda Shoenfeld, Antoni Sisó-Almirall, Athanasios G. Tzioufas, Claudio Vitali, Simon Bowman, Xavier Mariette
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Aims:</h3> The therapeutic management of Sjögren syndrome (SjS) has not changed substantially over the past decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed to develop the first EULAR evidence-, consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organizations following the 2014 EULAR standardized operating procedures. <h3>Methods:</h3> The Task Force included rheumatologists, specialists in internal medicine, oral care specialists, ophthalmologists, gynaecologists, dermatologists, epidemiologists, statisticians, GPs, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. On the basis of the research questions, a systematic literature search between January 1986 and December 2017 was carried out. Summary-of-findings tables were generated and levels of evidence were determined according to the study design using the standards of the Oxford CEBM. A web-based Delphi procedure was carried out in order to reach consensus. For each statement, the grade of recommendation was based on the maximum level of evidence achieved in the SLR using the 4-point scale CEBM categorization. Consensus for endorsement was defined as an agreement score of at least 8 on a 0-10 scale by more than 80% of participants. <h3>Results:</h3> The Task Force endorsed the presentation of general principles for the management of patients with SjS as 3 overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic, extraglandular disease (Table 1). <h3>Conclusion:</h3> The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the area of management of primary 2002 SjS patients and on discussions by a large and broadly international Task Force. The recommendations synthesise the current thinking on approaching SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations. <h3>Disclosure of Interests:</h3> None declared