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Despite its significant clinical and socioeconomic burden, no disease-modifying therapies have yet been approved. Current management remains largely symptomatic, reflecting the complexity and heterogeneity of the disease and the limitations of past clinical trials. Recent advances in the understanding of SjD immunopathogenesis have clarified key mechanisms including epithelial activation, interferon-driven inflammation, B-cell hyperactivity and T-cell dysregulation. These insights have fuelled the development of targeted therapies designed to modulate specific immune pathways, aiming to interrupt the self-perpetuating cycle of epithelial injury and immune activation. Emerging strategies include the modulation of B-cell survival and signalling, inhibition of IgG recycling and intracellular kinase pathways and blockade of co-stimulatory interactions between immune cells. Although recent phase II and phase III studies have shown encouraging signs of efficacy, they have largely focused on patients with moderate-to-severe systemic disease. Addressing the unmet therapeutic need in individuals with predominantly glandular or low systemic activity remains a major challenge. Continued refinement of outcome measures and patient stratification will be essential to translate mechanistic advances into effective, personalised treatments capable of altering the natural course of SjD.<\/jats:p>","DOI":"10.1136\/rmdopen-2024-004310","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:10:17Z","timestamp":1782317417000},"page":"e004310","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Emerging treatments for Sj\u00f6gren\u2019s disease: promising drugs on the 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