Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12950-017-0174-3
Title: Systematic review of randomized controlled trials in the treatment of dry eye disease in Sjogren syndrome
Authors: Shih, K.C
Lun, C.N
Jhanji, V
Thong, B.Y.-H
Tong, L 
Keywords: antiinflammatory agent
balafilcon A
cevimeline
corticosteroid
cyclosporin
diclofenac
diquafosol
etanercept
fluorometholone
gamma linolenic acid
hydroxychloroquine
indometacin
lactoferrin
nonsteroid antiinflammatory agent
pilocarpine
placebo
prasterone
unclassified drug
comparative effectiveness
disease association
drug efficacy
drug safety
dry eye
gastrointestinal symptom
human
injection site reaction
outcome assessment
randomized controlled trial (topic)
Review
Sjoegren syndrome
systematic review
systemic therapy
treatment duration
unspecified side effect
Issue Date: 2017
Citation: Shih, K.C, Lun, C.N, Jhanji, V, Thong, B.Y.-H, Tong, L (2017). Systematic review of randomized controlled trials in the treatment of dry eye disease in Sjogren syndrome. Journal of Inflammation (United Kingdom) 14 (1) : 26. ScholarBank@NUS Repository. https://doi.org/10.1186/s12950-017-0174-3
Rights: Attribution 4.0 International
Abstract: Primary Sjögren's syndrome is an autoimmune disease characterized by dry eye and dry mouth. We systematically reviewed all the randomized controlled clinical trials published in the last 15 years that included ocular outcomes. We found 22 trials involving 9 topical, 10 oral, 2 intravenous and 1 subcutaneous modalities of treatment. Fluoromethalone eye drops over 8 weeks were more effective than topical cyclosporine in the treatment of dry eye symptoms and signs; similarly, indomethacin eye drops over 1 month were more efficacious than diclofenac eye drops. Oral pilocarpine 5 mg twice daily over 3 months was superior to use of lubricants or punctal plugs for treating dry eye, but 5% of participants had gastrointestinal adverse effects from pilocarpine, though none discontinued treatment. In contrast, etanercept, a TNF-alpha blocking antibody, administered as subcutaneous injections twice weekly, did not improve dry eye significantly compared to placebo injections. In conclusion, topical corticosteroids have been shown to be effective in dry eye associated with Sjögren's syndrome. As some topical non-steroidal anti-inflammatory drugs may be more effective than others, these should be further evaluated. Systemic secretagogues like pilocarpine have a role in Sjögren's syndrome but the adverse effects may limit their clinical use. It is disappointing that systemic cytokine therapy did not produce encouraging ocular outcomes but participants should have assessment of cytokine levels in such trials, as those with higher baseline cytokine levels may respond better. (229 words) © 2017 The Author(s).
Source Title: Journal of Inflammation (United Kingdom)
URI: https://scholarbank.nus.edu.sg/handle/10635/181236
ISSN: 14769255
DOI: 10.1186/s12950-017-0174-3
Rights: Attribution 4.0 International
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