2019 EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF SJöGREN?S SYNDROME WITH TOPICAL AND SYSTEMIC THERAPIES

BRITO ZERON PILAR; SALVATORE DE VITA; JACQUES-ERIC GOTTENBERG; BELCHIN KOSTOV; WAN-FAI NG; YEHUDA SHOENFELD; CLAUDIO VITALI; STEFANO BOMBARDIERI; THOMAS DÖRNER; GABRIELA HERNÁNDEZ-MOLINA; AIKE A. KRUIZE; RETAMOZO SOLEDAD; ANTONI SISÓ-ALMIRALL; SIMON BOWMAN ; MANUEL RAMOS-CASALS; HENDRIKA BOOTSMA; BENJAMIN A. FISHER; AGNES KOCHER; THOMAS MANDL; RAPHAÈLE SEROR; ATHANASIOS G. TZIOUFAS; XAVIER MARIETTE

Madrid

Congreso; EULAR 2019 ? Annual European Congress of Rheumatology; 2019

The European League Against Rheumatism (EULAR)

Aims: The therapeutic management of Sjögren syndrome (SjS) has not changedsubstantially over the past decades: treatment decisions remain challenging inclinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European LeagueAgainst Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed to develop the first EULAR evidence-,consensus-based recommendations for the management of patients with SjS withtopical and systemic medications. The aim was to develop a rational therapeuticapproach to SjS patients useful for healthcare professionals, doctors in specialisttraining, medical students, pharmaceutical industries and drug regulatory organizations following the 2014 EULAR standardized operating procedures.Methods: The Task Force included rheumatologists, specialists in internal medicine, oral care specialists, ophthalmologists, gynaecologists, dermatologists, epidemiologists, statisticians, GPs, nurses and patient representatives from 30countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previoussets of criteria was considered and extrapolated. On the basis of the researchquestions, a systematic literature search between January 1986 and December2017 was carried out. Summary-of-findings tables were generated and levels ofevidence were determined according to the study design using the standards ofthe Oxford CEBM. A web-based Delphi procedure was carried out in order toreach consensus. For each statement, the grade of recommendation was basedon the maximum level of evidence achieved in the SLR using the 4-point scaleCEBM categorization. Consensus for endorsement was defined as an agreementscore of at least 8 on a 0-10 scale by more than 80% of participants.Results: The Task Force endorsed the presentation of general principles for themanagement of patients with SjS as 3 overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic, extraglandular disease (Table 1).Conclusion: The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the area of management of primary 2002 SjS patients and on discussions by a large and broadly international Task Force. The recommendations synthesise the current thinking on approaching SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.