The point on the ongoing B-cell depleting trials currently in progress over the world in primary Sjögren's syndrome

Abstract

Conventionnal therapy (moisturizers, pilocarpine, Cevimeline, local Cyclosporine, and hydroxychloroquine) remains the basis for the treatment of primary Sjögren's syndrome (pSS) but they do not modify the course of the disease. Rituximab is currently the most fully evaluated biologics in pSS. Open-label studies suggest that Rituximab is well tolerated (although infusion-related reactions and serum sickness remain possible), induces a rapid depletion of B cells in the blood and salivary glands, and could improve early active pSS or pSS with active extra glandular involvement. Two small double blind randomized studies have been conducted and now published, demonstrating its efficacy on fatigue and sicca syndrome in early disease. Two large double blind studies are currently ongoing or planned: The TEARS study (Tolerance and EfficAcy of Rituximab in primary Sjögren syndrome) in France, is currently including 120 patients having either a recent and active disease and/or at least one extraglandular severe signs. The 'TRACTISS' Study (Anti-B-Cell Therapy In Patients With Primary Sjögren's Syndrome), in UK, will include 100 patients having anti-Ro/La antibodies, reduced basal secretion but an increased salivary flow with stimulation, within 10years of diagnosis, symptomatic oral dryness, fatigue and at least one systemic feature.