{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:38:31Z","timestamp":1790890711798,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T00:00:00Z","timestamp":1591488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The current focus of treatment in primary Sj\u00f6gren's syndrome (<jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>) is symptom management. Since <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content> is an autoimmune disease with multisystem involvement, systemic immunosuppression may have a role in improving signs and symptoms and preventing progression. We undertook this review to assess the efficacy and safety of immunomodulation on primary SS from randomized clinical trials (RCTs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five electronic databases (Medline, Embase, Central, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>, and the World Health Organization International Clinical Trials Registry Platform) were searched to include RCTs for the treatment of <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>. Primary outcome measures included ocular dryness, oral dryness, tear production, and salivary function. Serious adverse events (<jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s) and withdrawals due to <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s were also assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The search yielded 32 trials evaluating 19 different medications. The average duration of diagnosis was long (up to 9.2 years). Twenty\u2010two trials examined ocular and oral dryness, for which only 2 and 4 trials showed statistically significant improvements, respectively. No studies found a benefit for tear production; few studies found improvements for unstimulated salivary flow (3 of 16 <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) and stimulated salivary flow (2 of 14 <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s). Meta\u2010analysis at 6 months found improvements as compared to placebo for unstimulated salivary flow (<jats:italic>P<\/jats:italic> = 0.003) and a decrease in the erythrocyte sedimentation rate (<jats:italic>P<\/jats:italic> = 0.007). No differences were seen for serious <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s, but there were increased withdrawals from <jats:styled-content style=\"fixed-case\">AE<\/jats:styled-content>s (risk ratio 2.33; <jats:italic>P<\/jats:italic> = 0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Reducing inflammation potentially improves salivary gland function. No individual immunomodulatory drug demonstrated a consistent benefit in xerostomia and xerophthalmia. Further work is needed to identify <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content> patients with an ability to improve and with outcomes that are valid and sensitive to change within clinical trials. Tradeoffs in the future between benefit and safety may also be important, because more withdrawals occurred with active treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23917","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T17:36:57Z","timestamp":1557164217000},"page":"1011-1021","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Meta\u2010Analysis of Treatment for Primary Sj\u00f6gren's Syndrome"],"prefix":"10.1002","volume":"72","author":[{"given":"Lucy L.","family":"Chu","sequence":"first","affiliation":[{"name":"Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangping","family":"Cui","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-5302","authenticated-orcid":false,"given":"Janet E.","family":"Pope","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine and Dentistry Western University, and St. Joseph's Health Care  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,7]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"247","article-title":"The epidemiology of Sj\u00f6gren's syndrome","volume":"6","author":"Patel R","year":"2014","journal-title":"Clin Epidemiol"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000275252"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(94)00125-O"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.143743"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.110619"},{"key":"e_1_2_6_8_1","volume-title":"Cochrane handbook for systematic reviews of interventions. 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