AB0483 A SYSTEMATIC LITERATURE REVIEW ON THE USE OF BIOLOGICS IN SJÖGREN’S SYNDROME
Authors: Asaad Qadri, Syed Mujtaba Bilgrami, Marwan Bukhari, Rheumatology Department
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Primary Sjögren’s syndrome (pSS) is a systemic chronic autoimmune disease characterized by dryness of the eyes and mouth. Current treatments provide modest benefit, leaving patients with limited therapeutic options. The pathophysiology of pSS involves hyperactivity of autoreactive lymphocytes. Biologic medications target mediators of the immune response. Modulation of autoimmunity in pSS with biologics has gained interest with open-label studies showing promising results. <h3>Objectives:</h3> This review aims to conduct a systematic literature review of interventional studies investigating the efficacy of biologics in the treatment of pSS. <h3>Methods:</h3> Literature was searched using the MEDLINE, EMBASE and PubMed databases as well as abstracts in EULAR, ACR and BSR. <h3>Results:</h3> A total of twelve studies met the inclusion criteria. Infliximab and etanercept showed no significant improvements in fatigue and dryness in pSS compared to placebo. Anakinra showed improvement in fatigue after <i>post-hoc</i> analysis. Small trials in rituximab showed significant improvements in oral and ocular dryness but failed to replicate this in two larger randomised control trials. Belimumab significantly reduced overall disease activity which was driven by improvements in dryness and parotid gland swelling. Open-label studies in epratuzumab and abatacept showed significant reductions in fatigue with abatacept also improving salivary flow and pain in pSS. <h3>Conclusion:</h3> Intervention with biologics in pSS has shown efficacy in alleviating pSS-associated fatigue and dryness in small RTCs and open-label trials. Larger randomised placebo-controlled trials have been inconsistent in replicating these results. This may be overcome by subgroup analysis, uptake of validated disease activity measuring tools, well-defined selection criteria to increase sample size and further understanding of pathophysiology in pSS. The small number of trials to date means the evidence base for biologics in pSS remains inconclusive. <h3>References</h3> [1] Mariette X, Ravaud P, Steinfeld S, Baron G, Goetz J, Hachulla E, et al. Inefficacy of infliximab in primary Sjögren’s syndrome: Results of the randomized, controlled trial of remicade in primary Sjögren’s syndrome (TRIPSS). Arthritis Rheum. 2004 Apr;50(4):1270–6. [2] Devauchelle-Pensec V, Mariette X, Jousse-Joulin S, Berthelot J-M, Perdriger A, Puéchal X, et al. Treatment of Primary Sjögren Syndrome With Rituximab. Ann Intern Med. 2014 Feb 18;160(4):233–42. [3] Bowman SJ, Everett CC, O’Dwyer JL, Emery P, Pitzalis C, Ng W-F, et al. Randomized Controlled Trial of Rituximab and Cost-Effectiveness Analysis in Treating Fatigue and Oral Dryness in Primary Sjögren’s Syndrome. Arthritis Rheumatol. 2017 Jul;69(7):1440–50. [4] Mariette X, Seror R, Quartuccio L, Baron G, Salvin S, Fabris M, et al. Efficacy and safety of belimumab in primary Sjögren’s syndrome: results of the BELISS open-label phase II study. Ann Rheum Dis. 2015 Mar;74(3):526–31. <h3>Acknowledgement:</h3> I would like to thank Dr Marwan Bukhari for his advice in this manuscript and for providing clinical shadowing in rheumatology at the Royal Lancaster Infirmary. <h3>Disclosure of Interests:</h3> Asaad Qadri: None declared, Syed Mujtaba Bilgrami: None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen and Novartis.