Thread by @NeuroSjogrens

@AbrahamAubry Thread: Most DMARDS used in Sjogren's are those which have shown efficacy in related diseases and are off label uses. In part because Sjogren's gets so little research attention & systemic aspects of Sjogren's are seldom emphasized as much as sicca. 1/n

@AbrahamAubry 2/n In regards to NeuroSj use of classification criteria as selection criteria in studies excludes close to half of NeurSj patients. Even w/ limitations noted one can find smaller studies on DMARDS in Sjogrens. Here is a list of DMARDS: 1.hydroxychloroquine/chloroquine 2/n

@AbrahamAubry 3/n azathioprine, cyclosporine A, cyclophosphamide, leflunomide, methotrexate (oral and subcutaneous), and mycophenolate.

Biologic DMARDs: tumour necrosis factor (TNF) inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab)
3/n

@AbrahamAubry 4/n T‐cell co‐stimulation inhibitors (abatacept),  B‐cell targeting drugs (rituximab, belimumab, epratuzumab), interleukin‐6 (IL‐6) inhibitors (tocilizumab, sarilumab), and interleukin‐1 (IL‐1) inhibitors (anakinra).
4/n

@AbrahamAubry 5/n Targeted synthetic DMARDs: tofacitinib, baricitinib, upadacitinib, filgotinib.
Biosimilars: biological pharmaceuticals that are almost identical to an original product manufactured by a different company (e.g. CT‐P13 is an infliximab biosimilar).
5/n

@AbrahamAubry 6/n The above list is taken from a planned Cochrane review study. It has some of the same problems commonly seen in Sjogren's literature. In practice which DMARD gets selected can depend on practioner specialty & their familiarity w/ certain drugs & which organ damage. 6/n

@AbrahamAubry 7/n is being treated as well as whether a practitioner can get a drug authorized by insurance. The drugs I was thinking about when I wrote that post was hydroxychloroquine, Rituxan, IVIG & immunosuppressants mycophenolate & azathioprine. 7/n

@AbrahamAubry 8/n The Sjogren's Foundation clinical Practice Guidelines for systemic #NeuroSjogrens are currently being worked on, but the general & Pulmony CPG's have been published & can be found here: sjogrens.org/researchers-pr…

@AbrahamAubry 9/9 Note that the Sjogren's Foundation Clinical Practice Guidelines do not recommend TNF alpha inhibitors for sicca. I recommend perusing the Clinical Practice Guidelines for Sjogrens.

sjogrens.org/researchers-pr…

@AbrahamAubry @threadreaderapp unroll DMARDS in Sjogren's