Sjogren disease therapy reference (2026)

Sjogren disease therapy in 2026 organises around three tiers.

Symptomatic: artificial tears (multiple formulations), saliva substitutes and sialagogues (pilocarpine, cevimeline) for dry mouth, NSAIDs for joint pain, lifestyle support for fatigue and other systemic symptoms.

Off-label immunosuppression: hydroxychloroquine for systemic features, corticosteroids for severe systemic disease, methotrexate, azathioprine, mycophenolate, and rituximab for organ-threatening manifestations. None of these has formal Sjogren-disease approval.

Emerging mechanism-targeted tier: BAFF-targeted programs (ianalumab in pivotal data), CD40L-targeted programs (dazodalibep), other B-cell-targeted approaches, and mechanism programs targeting underlying T-cell biology. Some are entering pivotal trials with the goal of becoming the first specifically-approved systemic therapy.

The diagnostic and care-pathway question is significant. Sjogren disease is often diagnosed late, with primary symptoms (dryness) attributed to other causes. Schirmer testing, salivary gland imaging, anti-Ro and anti-La antibody testing, and salivary gland biopsy in selected patients are the standard workup; access to rheumatology evaluation is the gating clinical pattern.