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ICYMI: BSR Guideline on Management of Sjogren’s Syndrome

Jack Cush, MD

Sjögren disease (SD) is the most common of all autoimmune disease, yet little is know of its etiology and there are insufficient interventions for those affected with mucosal or systemic manifestations. The British Society of Rheumatology has updated its 2017 guidelines, with wider evidence and recommendations for the management of children and adolescents with SD. This article reviews the data and recommendations stemming from 19 questions on SD care.

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Update on Sjogren's disease trials

Md Yuzaiful Md Yusof, MRCP(UK), PhD

With better endpoint and patient selection strategy over the last 4 years, many new therapies have met their endpoints/shown promising signal in the Phase 2 randomised controlled trials in Sjogren's disease (iscalimab, ianalumab, dazodalibep, and sequential therapy belimumab + rituximab). Since many previous studies have shown the discordance between physician assessment and patient’s symptom burden, there is a glimmer of hope with the efficacy signals demonstrated by both iscalimab and dazodalibep in two patient cohorts; a) cohort 1 = high disease activity with variable symptom burden and b) cohort 2 = high symptom burden but low disease activity. EULAR 2024 offered additional updates.

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Canary in a Coal Mine (4.19.2024)

Jack Cush, MD

Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.

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ICYMI: BSR Guideline on Management of Sjogren’s Syndrome https://t.co/MMG3NmCeDl https://t.co/zKlR8jOkLD

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Dr. John Cush RheumNow ( View Tweet)
Rituximab to Treat Systemic Features of Sjogren's Dr. Yuz Yusof discusses abstract OP0076 presented at Eular 2024 in Vienna, Austria. https://t.co/9oJNz12cCI https://t.co/bZxpbf3PT9

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Dr. John Cush RheumNow ( View Tweet)
#EULAR2024 POS0375 Negative trial need to be reported too. Phase 2 RCT of S95011, an IL7-R antibody in moderate to severe systemic #Sjogren failed to meet primary endpoint (ESSDAI) or other secondary (ESSPRI, biomarkers). This inhibition unlikely to impact on SjD @RheumNow

Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)

#EULAR2024 POS0417 Using EXPLORE Inflammation I & II proteomics, marked immune dysregulation was seen in new ANA+ referral vs HC. 34% progressed to #lupus & #Sjogren. Six potential baseline biomarkers identified & closely resembled established SLE. Validation is ongoing @RheumNow https://t.co/I6HygqNwf7

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Nipocalimab (anti-FcRn - i.e. PLEX-in-a-bottle) with a positive phase 2 in Sjogren’s. This study is in high systemic dx pts (with nice response matching biological plausibility) - but salivary flow improved too ESSPRI didn’t quite make it, but close #EULAR2024 LBA0010 @RheumNow https://t.co/PslFKJBOOr

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David Liew drdavidliew ( View Tweet)
#EULAR2024 LBA0010 Promising Tx with diff mode of action in antibody+ #Sjogren. Phase 2 RCT Nipocalimab, anti-neonatal Fc receptor (FcRn)Ab that reduces IgG, met primary endpoint (clinESSDAI). Low SIE but doubled in lowest dose vs PBO (unrelated to IgG). On to Phase3 @RheumNow https://t.co/NlCc2l4zFL

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#EULAR2024 POS1245 Healthcare Administrative Data in Italy showed despite prevalence of 3.8/10,000, heathcare cost in #Sjogren was 3 x higher than the general population due to active disease & comorbidities. Call for better MDT approach in management @RheumNow https://t.co/EevoT4jkqr

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#SARD #ILD Who to screen for #rheumatic #diseases For ILD #ACR guidelines Screening May also depend on ILD prevalence Not sure if frequency of screening and how to screen @jeffsparks #ORA24 @ORAexec https://t.co/BcyyYLKvr6

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Janet Pope Janetbirdope ( View Tweet)
New hypothesis are explored in #Sjogren #EULAR2024 CB https://t.co/0glF5BGVO5

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Annals of the Rheumatic Diseases ARD_BMJ ( View Tweet)
Major pathogenic characteristics of #Sjogren disease #EULAR2024 CB https://t.co/3NeBBKIVT4

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Annals of the Rheumatic Diseases ARD_BMJ ( View Tweet)
Day 1 #EULAR2024 Do you want to learn about the effectiveness of rituximab for systemic features of #Sjogren and potential strategies to overcome non-response? Please come to my talk today (OP0076) and say hi 👋🏼 😃 Room C7 at 1720 hr CET @RheumNow https://t.co/uo2ivC5AeY

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
New targets and new treatments in #Sjogren’s disease: Long term outcomes of repeat cycles of RTX #EULAR2024 CB https://t.co/6fL3e33i8N

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Annals of the Rheumatic Diseases ARD_BMJ ( View Tweet)
STAR responder may be the way to go! Less placebo effect than CREST. Better in patients with low systemic activity. https://t.co/mMYOKfG2gS

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Bella Mehta bella_mehta ( View Tweet)
#EULAR2024 OP0008 Phase 2 #Sjogren RCT Iscalimumab, anti-CD40mAb in two cohorts (1=High systemic activity; 2=High symptom burden but low systemic) showed sustained improvement in ESSDAI & ESSPRI at 48wks in ISC-ISC group, as well as those switched at 24wks from PBO-ISC @RheumNow https://t.co/GuifDHA0lK

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#EULAR2024 OP0076 UK multicentre cohort study showed rituximab was effective in systemic features of #Sjogren in children & adults. One in 6 lost response in subsequent cycle due to antidrug antibodies. Humanised or type 2 antiCD20Ab in the future could improve this @RheumNow https://t.co/duYpr2yKGB

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
BSR Guideline on Management of Sjogren’s Syndrome Sjögren disease (SD) is the most common of all autoimmune disease, yet little is know of its etiology and there are insufficent interventions for those affected with mucosal or systemic manifestations. https://t.co/M5fQ8lyZBS https://t.co/30XpP3r4FV

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Dr. John Cush RheumNow ( View Tweet)
Biopsy Results in Sjogren's Syndrome Save A prospective study from the Netherlands analyzed the comparative value of simultaneous labial and parotid salivary gland biopsies performed in patients with sicca complaints and suspected SjD. https://t.co/meJgf7dI8N https://t.co/zHg6SgiufS

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Dr. John Cush RheumNow ( View Tweet)
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