The Efficiency of Hydroxychloroquine for the Treatment of Primary Sjögren's Syndrome: A Systematic Review and Meta-Analysis.

Xuan Wang,Tongyangzi Zhang,Yuanyuan Liang,Xingxing Fang,Shengnan Pan,Jiamin Song,Jianping Tang,Farooq Riaz,Zizhen Guo,Zhenzhen Wu,Run Feng,Jincheng Pu

doi:10.3389/fphar.2021.693796

Abstract

Objectives: This meta-analysis was conducted to evaluate the effects of hydroxychloroquine (HCQ) in the treatment of primary Sjögren’s syndrome (pSS).Methods: Nine databases were searched for data collection. We used clinical features, including involvement in superficial tissues and visceral systems, and experimental findings, including Schirmer’s test, unstimulated salivary flow rate (uSFR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and immunoglobulins (IgG, IgM and IgA) as major outcome measures. The Downs and Black quality assessment tool and RevMan 5.3 were used to assess the methodological quality and statistical analysis, respectively.Results: Thirteen studies with pSS patients, consisting of two randomized controlled studies, four retrospective studies and seven prospective studies were analyzed. Results showed that HCQ treatment significantly improved the oral symptoms of pSS patients compared to non-HCQ treatment (P = 0.003). Similar trends favoring HCQ treatment were observed for uSFR (p = 0.05), CRP (p = 0.0008), ESR (p < 0.00001), IgM (p = 0.007) and IgA (p = 0.05). However, no significant improvement was observed in other clinical features, including ocular involvement, fatigue, articular lesions, pulmonary, neurological and lymphoproliferative symptoms, renal organs and other experimental parameters in the HCQ treatment group compared to the non-HCQ treatment group.Conclusion: HCQ treatment showed moderate efficacy to improve oral symptoms, uSFR, ESR, CRP, IgM and IgA. However, HCQ could not alleviate organ-specific systemic involvement.Systematic Review Registration:We have registered on the PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], and the registration number is identifier [CRD42020205624]

Highlights

Primary Sjögren’s Syndrome, with an estimated worldwide prevalence of 0.06% (Qin et al, 2015), is a chronic and systemic autoimmune disease that is characterized by focal lymphocytic infiltration of the exocrine glands causing oral and ocular dryness, fatigue and pain
Results showed that HCQ treatment significantly improved the oral symptoms of Primary Sjögren’s Syndrome (pSS) patients compared to non-HCQ treatment (P 0.003)
Similar trends favoring HCQ treatment were observed for unstimulated salivary flow rate (uSFR) (p 0.05), C-reactive protein (CRP) (p 0.0008), erythrocyte sedimentation rate (ESR) (p < 0.00001), IgM (p 0.007) and IgA (p 0.05)

Summary

Introduction

Primary Sjögren’s Syndrome (pSS), with an estimated worldwide prevalence of 0.06% (Qin et al, 2015), is a chronic and systemic autoimmune disease that is characterized by focal lymphocytic infiltration of the exocrine glands causing oral and ocular dryness, fatigue and pain These three symptoms are present in more than 80% of pSS patients and greatly compromise their quality of life (Meijer et al, 2009). In addition to the clinical manifestations of the salivary and lacrimal glands, a subset of patients showed extraglandular involvement with the development of signs and symptoms in other organs including skin, joints, lungs, gastrointestinal tract, kidneys, nervous and circulatory systems These systemic complications occur in approximately 30–40% of pSS patients. Laboratory indices including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and detection of immunoglobulins (IgG, IgM and IgA) are often used as markers to indicate disease development and activity (Shiboski et al, 2017)

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