Experience with an engineered biological therapy for Sjogren’s syndrome
DOI: 10.32364/2587-6821-2020-4-8-529-534
I.S. Svintsitskaya, K.Yu. Volkov, V.V. Tyrenko, D.I. Sopova
S.M. Kirov Military Medical Academy, St. Petersburg, Russian Federation
Sjogren’s syndrome (SS) a chronic slowly progressive autoimmune disorder caused by the production of anti-nuclear antibodies and B cell hyperactivity. This disease affects exo-crine glands and involves a number of other organs and systems. In SS with systemic manifes-tations that is resistant to standard corticosteroids and basic anti-inflammatory treatment, en-gineered biological therapies are recommended. B cells having an important pathogenic role in SS are the most promising therapeutic target. Multiple comorbidities should not be considered the contraindications to anti-B-cell therapy. The paper addresses a case study of SS in a 68-year-old woman and authors’ experience with engineered biological therapy (rituximab). Rituximab treatment resulted in the significant clinical improvement as demonstrated by the reduction in dry mouth and dry eye symptoms, the improvements in exercise tolerance, ab-dominal pain relief, and improved dyspnea. Laboratory tests also showed the reduction in the acute phase and immunological activity of SS.
Keywords: Sjogren’s syndrome, autoimmune disorder, engineered biological therapy, anti-B-cell therapy, dryness, xerostomia, xerophthalmia, rituximab.
For citation: Svintsitskaya I.S., Volkov K.Yu., Tyrenko V.V., Sopova D.I. Experience with an engineered biological therapy for Sjogren’s syndrome. Russian Medical Inquiry. 2020;4(8):529–534. DOI: 10.32364/2587-6821-2020-4-8-529-534.
Irina S. Svintsitskaya — Cand. of Sci. (Med.), senior lecturer of the Department of Faculty Therapy, S.M. Kirov Military Medical Academy, 6Zh, Academician Lebedev str., St. Petersburg, 194044, Russian Federation; ORCID iD 0000-0002-1317-8276.
Konstantin Yu. Volkov — senior resident of Rheumatological Department, S.M. Kirov Military Medical Academy, 6Zh, Academician Lebedev str., St. Petersburg, 194044, Russian Federation; ORCID iD 0000-0001-8310-5323.
Vadim V. Tyrenko — Doct. of Sci. (Med.), Professor, Head of the Department of Faculty Therapy, S.M. Kirov Military Medical Academy, 6Zh, Academician Lebedev str., St. Petersburg, 194044, Russian Federation; ORCID iD 0000-0002-0470-1109.
Daria. I. Sopova — cadet of the 6th course, S.M. Kirov Military Medical Academy, 6Zh, Academician Lebedev str., St. Petersburg, 194044, Russian Federation; ORCID iD 0000-0002-0823-6435.
Contact information: Irina S. Svintsitskaya, e-mail: sonirinadoc@mail.ru. Financial Disclosure: no authors have a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 01.10.2020, revised 15.10.2020, accepted 29.10.2020.
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2. Both T., Dalm V.A., van Hagen P.M., van Daele P.L. Reviewing primary Sjögren’s syndrome: beyond the dryness — From pathophysiology to diagnosis and treatment. Int J Med Sci. 2017;14(3):191–200. DOI: 10.7150/ijms.17718.
3. Seror R., Bowman S.J., Brito-Zeron P. et al. EULAR Sjogran’s syndrome disease activity index (ESSDAI): a user guide. RMD. 2015;1:1–9. DOI: 10.1136/rmdopen-2014-000022.
4. Russian clinical guidelines. Rheumatology. Ed. E.L. Nasonova. M.: GEOTAR-Media; 2017 (in Russ.).
5. Mariette X., Criswell L.A. Primary Sjögren’s syndrome. N Engl J Med. 2018;378:931–939. DOI: 10.1056/NEJMcp1702514.
6. Bowman S.J., Everett C.C., O’Dwyer J.L. et al. Randomized Controlled Trial of Rituximab and Cost-Effectiveness Analysis in Treating Fatigue and Oral Dryness in Primary Sjögren’s Syndrome. Arthritis Rheumatol. 2017;69(7):1440–1450. DOI: 10.1002/art.40093.
7. Carsons S.E., Vivino F.B., Parke A. et al. Treatment Guidelines for Rheumatologic Manifestations of Sjögren’s Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain. Arthritis Care Res (Hoboken). 2017;69(4):517–527. DOI: 10.1002/acr.22968.
8. Nocturne G., Cornec D., Seror R., Mariette X. Use of Biologics in Sjögren’s Syndrome. Rheum Dis Clin North Am. 2016;42(3):407–417. DOI: 10.1016/j.rdc.2016.03.001.
9. Gandolfo S., De Vita S. Double anti-B cell and anti-BAFF targeting for the treatment of primary Sjögren’s syndrome. Clin Exp Rheumatol. 2019;37 Suppl 118 (3):199–208.
10. Grigoriadou S., Chowdhury F., Pontarini E. et al. B cell depletion with rituximab in the treatment of primary Sjögren’s syndrome: what have we learnt? Clin Exp Rheumatol. 2019;37 Suppl 118 (3):217–224.
11. Verstappen G.M., van Nimwegen J.F., Vissink A. et al. The value of rituximab treatment in primary Sjögren’s syndrome. Clin Immunol. 2017;182:62–71. DOI: 10.1016/j.clim.2017.05.002.
12. Gandolfo S., De Vita S. Emerging drugs for primary Sjögren’s syndrome. Expert Opin Emerg Drugs. 2019;24(2):121–132. DOI: 10.1080/14728214.2019.1634052.
13. Fisher B.A., Everett C.C., Rout J. et al. Effect of rituximab on a salivary gland ultrasound score in primary Sjögren’s syndrome: results of the TRACTISS randomised double-blind multicentre substudy. Ann Rheum Dis. 2018;77(3):412–416. DOI: 10.1136/annrheumdis-2017-212268.
14. Fasano S., Isenberg D.A. Present and novel biologic drugs in primary Sjögren’s syndrome. Clin Exp Rheumatol. 2019;37 Suppl 118 (3):167–174.
15. Torgashina A.V., Vasiliev V.I. The efficacy of rituximab in the treatment of opticomyelitis-associated disorder in a patient with Sjogren’s disease. Terapevticheskiy arkhiv. 2018;90(5):76–80. DOI: 10.26442/terarkh201890576-80 (in Russ.).
16. Benevolenskaya S.S., Korolkova A.A., Myachikova V. Yu. et al. Combined biological therapy with belimumab and rituximab in a patient with Sjogren’s disease. Terapiya. 2019;5(8):140–150. DOI: 10.18565/therapy.2019.8.140-150 (in Russ.).
17. Nasonov E.L. New directions of pharmacotherapy of immunoinflammatory rheumatic diseases. Terapevticheskiy arkhiv. 2019;91(8):98–107. DOI: 10.18565/therapy.2019.6.151-162 (in Russ.).
18. Repin I.S., Vasilyeva Yu.N., Kozlova M.V., Smyslenova M.V. Ultrasound examination of the parotid salivary glands in patients with Sjogren’s syndrome. Dental Forum. Limited Liability Company "Forum of Dentistry". 2015;3:58–62 (in Russ.).
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