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Therapeutic Recommendations for the Management of Older Adult Patients with Sjögren’s Syndrome

Retamozo, Soledad ; Baldini, Chiara ; Bootsma, Hendrika ; De Vita, Salvatore ; Dörner, Thomas ; Fisher, Benjamin A. ; Gottenberg, Jacques-eric ; Hernández-molina, Gabriela ; Kocher, Agnes and Kostov, Belchin , et al. (2021) In Drugs & Aging 38(4). p.265-284
Abstract
Primary Sjögren’s syndrome (SjS) is a systemic autoimmune disease most commonly diagnosed in middle-aged women. Although the disease can occur at all ages, it is diagnosed between 30 and 60 years of age in two-thirds of patients. In more than 20% of cases, the people are older than 65 years. In this review, we focus on the therapeutic management of primary SjS in older patients, following the recently published 2020 European League Against Rheumatism (EULAR) recommendations for the management of the disease with topical and systemic therapies. These recommendations are applicable to all patients with primary SjS regardless of age at diagnosis, although the therapeutic management in older patients requires additional considerations. Older... (More)
Primary Sjögren’s syndrome (SjS) is a systemic autoimmune disease most commonly diagnosed in middle-aged women. Although the disease can occur at all ages, it is diagnosed between 30 and 60 years of age in two-thirds of patients. In more than 20% of cases, the people are older than 65 years. In this review, we focus on the therapeutic management of primary SjS in older patients, following the recently published 2020 European League Against Rheumatism (EULAR) recommendations for the management of the disease with topical and systemic therapies. These recommendations are applicable to all patients with primary SjS regardless of age at diagnosis, although the therapeutic management in older patients requires additional considerations. Older patients are more likely to have pulmonary, liver, kidney, or heart-related comorbidities (even cognitive disturbances); caution is required when most drugs are used, including muscarinic agents, systemic corticosteroids and synthetic immunosuppressants. It is also important to monitor the use of eye drops containing steroids due to the increased risk of developing cataracts, a frequent ocular complication in the older population. In contrast, the majority of drugs that can be used topically (pilocarpine rinses, eye drops containing topical non-steroidal anti-inflammatory drugs (NSAIDs) or cyclosporine A, topical dermal formulations of NSAIDs) have shown an acceptable safety profile in older patients, as well as rituximab. A rigorous evaluation of the medical history of older patients is essential when drugs included in the EULAR guidelines are prescribed, with special attention to factors frequently related to ageing, such as polypharmacy, the existence of organ-specific comorbidities, or the enhanced susceptibility to infections. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Drugs & Aging
volume
38
issue
4
pages
265 - 284
publisher
Adis International
external identifiers
  • scopus:85101684809
  • pmid:33619703
ISSN
1170-229X
DOI
10.1007/s40266-021-00838-6
language
English
LU publication?
yes
id
be9ca0e7-3ad0-47ac-b279-a5475eb2b7fd
date added to LUP
2021-02-23 20:00:08
date last changed
2021-05-26 03:00:04
@article{be9ca0e7-3ad0-47ac-b279-a5475eb2b7fd,
  abstract     = {Primary Sjögren’s syndrome (SjS) is a systemic autoimmune disease most commonly diagnosed in middle-aged women. Although the disease can occur at all ages, it is diagnosed between 30 and 60 years of age in two-thirds of patients. In more than 20% of cases, the people are older than 65 years. In this review, we focus on the therapeutic management of primary SjS in older patients, following the recently published 2020 European League Against Rheumatism (EULAR) recommendations for the management of the disease with topical and systemic therapies. These recommendations are applicable to all patients with primary SjS regardless of age at diagnosis, although the therapeutic management in older patients requires additional considerations. Older patients are more likely to have pulmonary, liver, kidney, or heart-related comorbidities (even cognitive disturbances); caution is required when most drugs are used, including muscarinic agents, systemic corticosteroids and synthetic immunosuppressants. It is also important to monitor the use of eye drops containing steroids due to the increased risk of developing cataracts, a frequent ocular complication in the older population. In contrast, the majority of drugs that can be used topically (pilocarpine rinses, eye drops containing topical non-steroidal anti-inflammatory drugs (NSAIDs) or cyclosporine A, topical dermal formulations of NSAIDs) have shown an acceptable safety profile in older patients, as well as rituximab. A rigorous evaluation of the medical history of older patients is essential when drugs included in the EULAR guidelines are prescribed, with special attention to factors frequently related to ageing, such as polypharmacy, the existence of organ-specific comorbidities, or the enhanced susceptibility to infections.},
  author       = {Retamozo, Soledad and Baldini, Chiara and Bootsma, Hendrika and De Vita, Salvatore and Dörner, Thomas and Fisher, Benjamin A. and Gottenberg, Jacques-eric and Hernández-molina, Gabriela and Kocher, Agnes and Kostov, Belchin and Kruize, Aike A. and Mandl, Thomas and Ng, Wan-fai and Seror, Raphaèle and Shoenfeld, Yehuda and Sisó-almirall, Antoni and Tzioufas, Athanasios G. and Vissink, Arjan and Vitali, Claudio and Bowman, Simon J. and Mariette, Xavier and Ramos-casals, Manuel and Brito-zerón, Pilar},
  issn         = {1170-229X},
  language     = {eng},
  month        = {02},
  number       = {4},
  pages        = {265--284},
  publisher    = {Adis International},
  series       = {Drugs & Aging},
  title        = {Therapeutic Recommendations for the Management of Older Adult Patients with Sjögren’s Syndrome},
  url          = {http://dx.doi.org/10.1007/s40266-021-00838-6},
  doi          = {10.1007/s40266-021-00838-6},
  volume       = {38},
  year         = {2021},
}