***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE There is evidence to support a dominant role for B cells in the pathophysiology of primary Sjögren 's syndrome ( SS ) . Therefore , we evaluated the safety and efficacy of anti-CD20 monoclonal antibody . METHODS Sixteen patients who met the new American-European Consensus Group criteria for primary SS and scored > 50 on at least 2 of 4 visual analog scales ( VAS ; 100 mm ) evaluating global disease , pain , fatigue , and global dryness received infusions of low-dose rituximab ( 375 mg/m(2 ) ) at weeks 0 and 1 without steroid premedication . RESULTS Slow rituximab infusions ( 100 mg/hour ) were well tolerated , with only 1 patient experiencing serum sickness-like disease . There was a dramatic reduction in B cells of the blood and salivary gl and ( SG ) . At week 12 , VAS scores with respect to fatigue and dryness ( P < 0.05 ) , tender point count ( P < 0.035 ) , and quality of life as evaluated by the Short Form 36 question naire ( SF-36 ; P < 0.001 ) were significantly improved . At week 36 , significant improvements were noted in the 4 VAS scores ( P < 0.05 ) , tender joint count ( P = 0.017 ) , tender point count ( P = 0.027 ) , and SF-36 ( P < 0.03 ) . Pulmonary manifestations were ameliorated in 1 patient . Patients with improvements on at least 3 of the 4 VAS scores at any visit ( n = 11 ) had a shorter disease duration than the other patients ( n = 5 ; mean + /- SD duration 3.8 + /- 5.4 versus 30.1 + /- 29.5 years ; P = 0.02 ) . CONCLUSION Low-dose rituximab infusions were well tolerated without the benefit of steroids . Infusions induced a rapid depletion of B cells in the blood and SG and could improve primary SS . Controlled studies are needed The aim of this study was to evaluate the efficacy and safety of mycophenolate sodium ( MPS ) in patients with primary Sjögren syndrome ( pSS ) refractory to other immunosuppressive agents . Eleven patients with pSS were treated with MPS up to 1,440 mg daily for an observation period of 6 months in this single-center , open-label pilot trial . At baseline , after 3 months , and after 6 months , we examined the clinical status , including gl and ular function tests , as well as different laboratory parameters associated with pSS . In addition , subjective parameters were determined on the basis of different question naires . Treatment with MPS was well tolerated in 8 of 11 patients . Due to vertigo or gastrointestinal discomfort , two patients did not complete the trial . One patient developed pneumonia 2 weeks after treatment and was withdrawn . In the remaining patients , MPS treatment result ed in subjective improvement of ocular dryness on a visual analogue scale and a reduced dem and for artificial tear supplementations . However , no significant alterations of objective parameters for dryness of eyes and mouth were observed , although a substantial improvement of gl and ular functions occurred in two patients with short disease duration . In addition , treatment with MPS result ed in significant reduction of hypergammaglobulinemia and rheumatoid factors as well as an increase of complement levels and white blood cells .  MPS promises to be an additional therapeutic option for patients with pSS , at least in those with shorter disease duration . Further investigations about the efficacy and safety of MPS in pSS have to be performed in larger numbers of patients OBJECTIVES --In 1985 and 1988 a positive effect of treatment of primary Sjögren 's syndrome with hydroxychloroquine was reported in two small open studies . To investigate further the clinical and laboratory effects of hydroxychloroquine in primary Sjögren 's syndrome a two year study was performed . METHODS --The design of the study included a prospect i ve , placebo controlled , two year double blind crossover trial in 19 patients . RESULTS --A significant decrease in IgG and IgM and a tendency for a decrease in the erythrocyte sedimentation rate ( ESR ) during treatment with hydroxychloroquine compared with treatment with placebo were found . No beneficial clinical effect of the use of hydroxychloroquine as expressed in preference for treatment with hydroxychloroquine or placebo with regard to symptoms and signs of primary Sjögren 's syndrome could be shown , however , nor any relevant change in tear gl and activity and sequelae of peripheral tear function deficiency , nor salivary gl and scintigraphy . CONCLUSIONS --The use of hydroxychloroquine at a dose of 400 mg daily taken over a 12 month period does not have a worthwhile clinical benefit in patients with primary Sjögren 's syndrome despite an improvement of hyperglobulinaemia and slight changes in the ESR and OBJECTIVE To compare the efficacy and safety of cyclosporin A ( [ CsA ] 0.05 % and 0.1 % ophthalmic emulsions ) to vehicle in patients with moderate to severe dry eye disease . DESIGN Multicenter , r and omized , double-masked , parallel-group , 6-month , vehicle-controlled . PARTICIPANTS A total of 877 patients with defined moderate to severe dry eye disease ( 292 to 293 in each treatment group ) . METHODS Two identical clinical trials ; patients were treated twice daily with either CsA , 0.05 % or 0.1 % , or vehicle . The results of these two trials were combined for analysis . MAIN OUTCOME MEASURES EFFICACY corneal and interpalpebral dye staining , Schirmer tear test ( with and without anesthesia ) , tear break-up time , Ocular Surface Disease Index ( OSDI ) , facial expression , patient subjective rating scale , symptoms of dry eye , investigator 's evaluation of global response to treatment , treatment success , and daily use of artificial tears . SAFETY occurrence of adverse events , best-corrected visual acuity , intraocular pressure , biomicroscopy , and blood trough CsA concentrations . RESULTS Treatment with CsA , 0.05 % or 0.1 % , gave significantly ( P < or = 0.05 ) greater improvements than vehicle in two objective signs of dry eye disease ( corneal staining and categorized Schirmer values ) . CsA 0.05 % treatment also gave significantly greater improvements ( P < 0.05 ) in three subjective measures of dry eye disease ( blurred vision , need for concomitant artificial tears , and the physician 's evaluation of global response to treatment ) . There was no dose-response effect . Both CsA treatments exhibited an excellent safety profile , and there were no significant topical or systemic adverse safety findings . CONCLUSIONS The novel ophthalmic formulations CsA 0.05 % and 0.1 % were safe and effective in the treatment of moderate to severe dry eye disease yielding improvements in both objective and subjective measures . Topical CsA represents a new pharmacologically based treatment for dry eye disease that may provide significant patient benefits Twenty-six patients with primary or secondary Sjögren 's syndrome were treated in a double-blind , cross-over trial for a four week period with oral N-Acetylcysteine and placebo . Before treatment there were significantly elevated salivary lactoferrin levels in the patients when compared to 51 healthy controls ( p = 0.0005 ) , and significantly decreased levels of tear lysozyme when compared to 24 controls ( p = 0.0003 ) . Salivary sodium , potassium , inorganic phosphate , amylase and immunoglobulin G , A or M levels were not significantly different from control values . After treatment with N-Acetylcysteine , Sjögren 's syndrome patients reported improvements in ocular soreness ( p = 0.004 ) , ocular irritability ( p = 0.006 ) , halitosis ( p = 0.033 ) and daytime thirst ( p = 0.033 ) . N-Acetylcysteine , but not placebo improved the van Bijsterveld score ( p = 0.026 ) , but neither agent improved the Schirmer test , the tear break up time or any of the laboratory tests . These results suggest that N-Acetylcysteine may have a true therapeutic effect on the ocular symptoms of Sjögren 's syndrome and be worthy of a longer study OBJECTIVE To study the efficacy and safety of B cell depletion with rituximab , a chimeric murine/human anti-CD20 monoclonal antibody , in patients with primary Sjögren 's syndrome ( SS ) in a double-blind , r and omized , placebo-controlled trial . METHODS Patients with active primary SS , as determined by the revised American-European Consensus Group criteria , and a rate of stimulated whole saliva secretion of > or = 0.15 ml/minute were treated with either rituximab ( 1,000 mg ) or placebo infusions on days 1 and 15 . Patients were assigned r and omly to a treatment group in a ratio of 2:1 ( rituximab : placebo ) . Followup was conducted at 5 , 12 , 24 , 36 , and 48 weeks . The primary end point was the stimulated whole saliva flow rate , while secondary end points included functional , laboratory , and subjective variables . RESULTS Thirty patients with primary SS ( 29 female ) were r and omly allocated to a treatment group . The mean + /- SD age of the patients receiving rituximab was 43 + /- 11 years and the disease duration was 63 + /- 50 months , while patients in the placebo group were age 43 + /- 17 years and had a disease duration of 67 + /- 63 months . In the rituximab group , significant improvements , in terms of the mean change from baseline compared with that in the placebo group , were found for the primary end point of the stimulated whole saliva flow rate ( P = 0.038 versus placebo ) and also for various laboratory parameters ( B cell and rheumatoid factor [ RF ] levels ) , subjective parameters ( Multidimensional Fatigue Inventory [ MFI ] scores and visual analog scale [ VAS ] scores for sicca symptoms ) , and extragl and ular manifestations . Moreover , in comparison with baseline values , rituximab treatment significantly improved the stimulated whole saliva flow rate ( P = 0.004 ) and several other variables ( e.g. , B cell and RF levels , unstimulated whole saliva flow rate , lacrimal gl and function on the lissamine green test , MFI scores , Short Form 36 health survey scores , and VAS scores for sicca symptoms ) . One patient in the rituximab group developed mild serum sickness-like disease . CONCLUSION These results indicate that rituximab is an effective and safe treatment strategy for patients with primary SS Background / purpose Sjögren 's syndrome ( SS ) is characterized by diminished exocrine secretions with the result ant symptoms of dry mouth and dry eye . As genetic predisposition and ethnicity may alter the effectiveness of drug treatment , evaluation of the efficacy and safety of the secretagogue pilocarpine hy-drochloride in the treatment of xerostomia in patients with SS in different population s is needed . Methods Forty-four patients with SS were enrolled in this double-blind , placebo-controlled trial . Patients were r and omized to receive 5 mg pilocarpine ( Salagen ) or placebo tablet four times daily for 12 weeks . Global evaluation and subjective responses of patients were assessed by question naires with visual analog scales and categorical checkboxes . Saliva production was also measured by modified Saxon 's test . Results Pilocarpine treatment significantly improved global assessment of dry mouth , symptoms associated with dry mouth ( mouth comfort , ability to sleep and ability to speak ) , and saliva production compared to placebo . The drug was well tolerated and the most common adverse effect was sweating ( 5/23 , 21.7 % ) result ing from the muscarinic agonist action of the drug . No serious drug-related adverse effect was found in this study . Conclusion The results of this study suggest that therapy with 5 mg pilocarpine four times daily is effective , safe and well tolerated for the relief of oral symptoms in patients with SS in Taiwan BACKGROUND Up to now no satisfying systemic treatment is available for patients with primary Sjögren 's syndrome . METHODS In a prospect i ve , open study we investigated the effect of D-penicillamine ( first three months 250 mg/day , next three months 500 mg/day ) on clinical and immunological parameters in 19 patients with primary Sjögren 's syndrome and a mean disease duration of 3.8 years . RESULTS Eight patients had to stop treatment mainly due to severe ( reversible ) loss of taste . Clinical ly , a statistically significant increase in basal salivary flow was observed after three months ( p<0.05 ) . In addition , improvement was noted in the Schirmer test and stimulated parotid salivary flow after six months , but these differences were not statistically significant . Laboratory values showed a decrease in ESR ( p<0.05 ) and levels of IgA and IgM ( both p<0.02 ) after six months , a decrease in levels of IgA-Rf and IgM-Rf after three months ( both p<0.05 ) , and an increase in haemoglobin level ( p<0.05 ) . CONCLUSION From this pilot study we conclude that the treatment of primary Sjögren 's syndrome with D-penicillamine has only marginal beneficial effects . Together with its clear side effects this means that D-penicillamine is unsuitable for this indication Background Matrix metalloproteinases ( MMPs ) are proteolytic enzymes that may contribute to tissue destruction in Sjögren 's syndrome ( 
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Small trials ( < 20 patients ) found no significant improvement in sicca outcomes for oral prednisone or hydroxychloroquine and limited benefits for immunosuppressive agents ( azathioprine and cyclosporine ) .
In primary Sjögren syndrome , evidence from controlled trials suggests benefits for pilocarpine and cevimeline for sicca features and topical cyclosporine for moderate or severe dry eye .