Sjogren's Quarterly: Treating Sjogren's - The Future

Over the years, as I've read the results of (far too few!) studies looking at various aspect of Sjogren's syndrome, the study authors conclude with a phrase similar to this one: more research needed. 

No kidding. It's disheartening to feel as though very little progress is being made in the diagnosis and treatment of our disease.

I was encouraged, however, as I read the Sjogren's Quarterly newsletter from the Sjogren's Syndrome Foundation Winter 2015 edition. It contains a piece entitled Treating Sjogren's - The Future! which reported progress made in increasing clinical trials, targets for new therapeutics, and validation of outcome measures for Sjogren's. Here's a few excerpts:

By Theresa Lawrence Ford, MD, Chair SSF Clinical Trials Consortium:  

While many barriers exist in getting new therapies to market in Sjogren's, tremendous progress has been made or is underway. Several factors are contributing to the increased interest and subsequent plans for clinical trials in Sjogren's, including the development of biomarkers; novel diagnostics that are coming onto the market to speed up and increase the precision of diagnosis as well as the numbers of those diagnosed; internationally-accepted classification criteria becoming finalized over the next year; and internationally-accepted outcome measures finally being in place.  

By Denise Faustman, MD, PhD:

Sjogren's is poised to benefit from the new era of drug development that we are entering for many diseases with the increasing possibility of tailoring therapies to a specific patient's needs. Therapies of the future most likely will be highly individualized by targeting specific signs and symptoms of Sjogren's...........In addition to new biologics currently under investigation, a combination or sequential use of different therapies may be found most efficacious. As mentioned earlier, a study published in 2014 by Salvatore De Vita et al using belimumab followed by rituximab demonstrated initial success and projected potential long-term benefits. We look forward to a better future in which more studies will expand our knowledge of the science exponentially and lead to more precise biomarkers and potential targets for therapeutics. That future is not far away. 

And this by Raphaele Seror, MD, Steering Committee, EULAR Outcome Measures in Sjogren's Syndrome:

Clinical trial design has made a major leap forward with the final validation of the EULAR-endorsed outcome measures known as the EULAR SS Disease Activity Index (ESSDAI) and EULAR SS Patient-Reported Index (ESSPRI). The validation study, published on March 2014, concludes a nearly decade-long effort by researchers to develop outcome measures that could be embraced consensually by the international community at large. The ESSDAI includes the 12 following domains: constitutional, lymphadenopathy, glandular, articular, cutaneous, pulmonary, renal, muscular, peripheral nervous system, central nervous system, haematological, and biological. The ESSPRI includes dryness, pain and fatigue that were considered by patients as the most important areas for needed improvement. 

You can read the article in it's entirety here which includes citations of the studies referenced, however keep in mind that this periodical's targeted audience is rheumatology health care professionals and the language and terms used reflect this.

I found the section by Dr. Faustman entitled Targets for New Therapeutics - The Science particularly interesting. In it, she describes potential therapies under investigation or being considered for use in the treatment of Sjogren's syndrome:

B cell inhibitors or modulators

• rituximab
• epratuzumab

BAFF/BLyS targets

• belimumab
• VAY736

T cell regulation and cytokine targets

• abatacept
• baminercept
• BCG vaccine
• tocilizumab

Genetics and epigenetics

Hope for more research resulting in increased knowledge and improved treatment of Sjogren's syndrome is a very good thing.