DMARDs and Immunosuppressants for Sjögren’s Disease

When Sjögren’s affects more than the eyes and mouth, doctors sometimes turn to drugs that calm the immune system. Two related groups are disease-modifying antirheumatic drugs (DMARDs) and immunosuppressants.^1-3

In Sjögren’s, the DMARD used most is methotrexate. This article explains how these drugs work, which are used, and what to expect.

How do DMARDs and immunosuppressants work?

In Sjögren’s, the immune system attacks the body’s own glands and tissues. DMARDs and immunosuppressants work by quieting an overactive immune system. DMARDs help regulate and control the body’s immune response, which can reduce inflammation and protect tissues from damage.^3,4

These drugs do not cure Sjögren’s. They aim to lower disease activity, especially when symptoms are more serious or affect the whole body.³

Examples

The main DMARD used in Sjögren’s is:^1,2,4

• Methotrexate (Trexall®) – A drug that suppresses the immune system, used to help with Sjögren’s symptoms. It is approved by the US Food and Drug Administration (FDA) for rheumatoid arthritis and other conditions, not for Sjögren’s.

Other drugs that suppress the immune system may be used in some cases. It is important to note that none of these drugs is FDA-approved specifically for Sjögren’s. They may be approved for other conditions. A doctor may prescribe them “off-label” for Sjögren’s when evidence suggests they help. Talk to your doctor about what is right for you.^1,3,4

What to expect

These drugs are generally used for more serious or whole-body disease. They work gradually.³

With methotrexate, it may take several weeks to a few months to feel the full benefit. Methotrexate for these uses is usually taken once a week, not daily, and taking it too often can cause severe harm, so follow your doctor’s directions exactly. Your doctor will order lab tests before and during treatment to watch how your body responds.⁴

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. With methotrexate, possible effects include:⁴

• Stomach upset – Nausea or vomiting can occur.
• Tiredness and dizziness – Some people feel drowsy or dizzy.
• Mouth sores – Sores or tender gums can develop.
• Hair loss – This can happen with treatment.

Methotrexate has a boxed warning, the strictest warning from the FDA. It has this warning because it can carry serious risks, including harm to an unborn baby and damage to the liver, lungs, and blood counts.⁴

These are not all the possible side effects of DMARDs and immunosuppressants. Talk to your doctor about what to expect when taking DMARDs and immunosuppressants. You also should call your doctor if you have any changes that concern you when taking DMARDs and immunosuppressants.

Other things to know

Before beginning treatment for Sjögren’s disease, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

Talk to your doctor

These drugs are powerful tools for serious disease, and they work differently for each person. Talk with your doctor about the benefits, the risks, and the monitoring involved.