Subconjunctival adalimumab for treatment of dry eye disease in Sjögren’s syndrome

Juliana Ferreira Da Costa Vargas,Thelma Skare,Marcelo Luiz Gehlen,Ana Tereza Ramos Moreira

doi:10.37039/1982.8551.20220003

Abstract

Objective To describe the use of subconjuctival administration of the anti-tumor necrosis factor agent adalimumab for treatment of dry eye in patients with Sjögren’s syndrome, and to investigate conjunctival healing. Methods Prospective, nonrandomized, noncomparative interventional case series including consecutive patients with Sjögren’s syndrome and dry eye disease treated with subconjunctival adalimumab, who were refractory to conventional treatment. Patients with infectious ocular surface involvement or structural changes in the tear pathway or eyelids were excluded. Data recorded included age, sex, [...]

Highlights

Sjögren’s syndrome is an autoimmune disease that affects the exocrine glands and is characterized by replacement of healthy tissue with lymphocytic infiltrate.[1]
It contributes to good visual acuity due to the corneal surface regularity provided by the tear film, which enhances refractive power.[7]. Other symptoms associated with this disorder include discomfort and visual disturbance, which are described by patients with dry eye disease (DED) as burning, foreign body sensation, itching, pain and blurred vision.[3]
Eye drops such as lubricants, autologous serum, diquafosol sodium, non-steroidal anti-inflammatory drugs, corticosteroids, cyclosporine and tacrolimus are recommended.[1,8] Local non-pharmacological therapies, such as punctal occlusion with plugs or other techniques, contact lens and pulsed light treatment, are other therapeutic alternatives.[1,8,9] Systemic treatment with the secretagogues pilocarpine and cevimeline was associated with statistically significant improvement in randomized controlled trials

Summary

Introduction

Sjögren’s syndrome is an autoimmune disease that affects the exocrine glands and is characterized by replacement of healthy tissue with lymphocytic infiltrate.[1]. 47 per 100,000 people may be affected in some European and Asian countries, where the incidence is higher.[2] According to the Sjögren’s Foundation, dry eye is the most detrimental and limiting symptom reported by patients with Sjögren’s syndrome, among other manifestations of the disease.[3]. It contributes to good visual acuity due to the corneal surface regularity provided by the tear film, which enhances refractive power.[7] Other symptoms associated with this disorder include discomfort and visual disturbance, which are described by patients with dry eye disease (DED) as burning, foreign body sensation, itching, pain and blurred vision.[3]. In patients with Sjögren’s syndrome, dry eye treatment often requires more efficient methods,(1) since traditional approaches tend to fail due to lack of tear production and inflammation. A variable percentage of patients treated with these drugs experience side effects such as sweating, gastrointestinal discomfort, headache and nausea.[10,11,12] they cannot be used in many patients with severe dry eye, even when topical therapeutic alternatives have failed

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