From the Guidelines
Sicca syndrome should be managed with a multi-faceted approach, including symptomatic relief using topical therapies, such as artificial tears and saliva substitutes, as well as systemic therapies like pilocarpine and hydroxychloroquine for more severe cases, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment of sicca syndrome involves a combination of topical and systemic therapies. Topical therapies include:
- Artificial tears (preservative-free) used 4-6 times daily for eye dryness
- Saliva substitutes like Biotène for oral dryness
- Nighttime lubricating ointments like Refresh PM or GenTeal Gel for longer-lasting relief during sleep Systemic therapies include:
- Pilocarpine (Salagen) 5mg three times daily to stimulate saliva production
- Hydroxychloroquine for patients with suspected IR-sicca syndrome, as recommended by the ESMO clinical practice guideline 1
Lifestyle Modifications
Lifestyle modifications are also important in managing sicca syndrome, including:
- Using a humidifier to add moisture to the air
- Avoiding dry environments and taking breaks from screen time (20-20-20 rule: every 20 minutes, look 20 feet away for 20 seconds)
- Avoiding medications that worsen dryness like antihistamines when possible
Systemic Disease Management
For patients with systemic disease, treatment should be tailored to organ-specific severity using the ESSDAI definitions, as recommended by the EULAR guidelines 1. Systemic therapies, such as glucocorticoids and immunosuppressive agents, may be considered for patients with active systemic disease, but only after a careful organ-by-organ evaluation of both severity and organ damage.
Recent Guidelines
The most recent guidelines, such as the NCCN Guidelines Insights: Management of Immunotherapy-Related Toxicities, Version 2.2024 1, recommend a similar approach to managing sicca syndrome, with a focus on symptomatic relief and systemic therapies for more severe cases. Overall, the management of sicca syndrome requires a comprehensive approach that addresses both the symptoms and the underlying systemic disease, with a focus on improving quality of life and reducing morbidity and mortality.
From the Research
Definition and Symptoms of Sicca
- Sicca syndrome is a condition characterized by dryness of the eyes (xerophthalmia) and mouth (xerostomia) 2, 3, 4, 5, 6
- It can be associated with various autoimmune disorders, such as Sjögren's syndrome 2, 4, 5, 6
- Symptoms of sicca syndrome include dry eyes, dry mouth, blurred vision, and artificial tear use 2
Treatment Options for Sicca
- Topical ocular 0.05% cyclosporine has been shown to improve Schirmer and corneal staining scores, blurred vision, and artificial tear use in patients with sicca syndrome 2
- Pilocarpine has been associated with improvements in dry mouth and dry eye symptoms in patients with Sjögren's syndrome 2, 4
- Cevimeline has also been shown to improve dry mouth and dry eye symptoms in patients with Sjögren's syndrome 2
- Artificial saliva has been compared to pilocarpine in the treatment of xerostomia and xerophthalmia in Sjögren's syndrome, with pilocarpine showing greater efficacy 4
Associations and Comorbidities
- Sicca symptoms have been associated with similar fatigue, anxiety, depression, and quality-of-life impairments in patients with and without primary Sjögren's syndrome 6
- Immune checkpoint inhibitor therapy has been linked to the development of sicca syndrome as an immune-related adverse event 3
- Salivary gland ultrasound (SGUS) has been used to characterize patients with sicca syndrome and evaluate the severity of dryness 5