Session Title: Sjögren's Syndrome - Clinical
Session Type: Abstract Submissions (ACR)
Background/Purpose: Sjögren´s syndrome (SS) is a chronic inflammatory autoimmune disease that is presented with lymphocytic infiltration of exocrine glands. Its secondary secretory dysfunction may involved extraglandular or extracraneal tissues. Antimalarials have been used for treatment of sicca symptoms and inflammation. However its effectiveness remains controversial. The objective of this systematic review is to evaluate the effectiveness and toxicity of antimalarials to treat adults with SS.
Methods: Between September 2010 and May 2012 we conducted an electronic search in the following databases: MEDLINE, Embase, LILACS, ISI WEB OF KNOWLEDGE, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry of the World Health Organization (WHO ICTRP). We included experimental, quasi-experimental and uncontrolled before and after studies. Evaluated outcomes were: improvement in xerophtalmia, xerostomia and Schirmer´s test; change in inflammatory markers and adverse events. Quality assessment of the trials was done by two authors independently. I2 and Chi-square tests were performed to estimate heterogeneity. The Mantel-Haenszel random-effects method with odds ratio (OR) as association measure were used for dichotomous outcomes, and mean difference for continuous data. All Statistical analysis was performed using RevMan 5.0
Results: 22 trials were found and 6 were included in the analysis. A total of 140 patients were included, all women. There were no statistically significant differences with respect to improvement in xerophtalmia (OR 2.27; 95% CI, 0.38 to 13.34), xerostomia (OR 1.0; 95% CI, 0.02 to 5) and Schirmer´s test (MD -1.03; 95% CI, -2.38 to 0.32). We observed a tendency in favor of antimalarials for decreasing erythrocyte sedimentation rate (MD –6.98; 95% CI, -20.73 to 6.76). One trial evaluated adverse effects (ocular, hepatic, hospitalization or dead) without significant differences. It was not possible to explore publication bias.
Conclusion: Up to the moment the available evidence has poor quality. The best evidence did not identify a clear benefit of antimalarials in the reviewed outcomes. The analyzed data reported low incidence of adverse events. More and good quality research (RCT´s) are needed to answer this question.
V. A. Coy,
C. E. Granados,
A. A. Iglesias-Gamarra,
J. F. Restrepo,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/antimalarials-for-sjogrens-syndrome-treatment-in-adults-meta-analysis/