<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.4 20241031//EN"
        "https://jats.nlm.nih.gov/publishing/1.4/JATS-journalpublishing1-4.dtd">
<article  article-type="reviewer-report"        dtd-version="1.4">
            <front>

                <journal-meta>
                                                                <journal-id>j. fac. pharm. ankara</journal-id>
            <journal-title-group>
                                                                                    <journal-title>Journal of Faculty of Pharmacy of Ankara University</journal-title>
            </journal-title-group>
                            <issn pub-type="ppub">1015-3918</issn>
                                        <issn pub-type="epub">2564-6524</issn>
                                                                                            <publisher>
                    <publisher-name>Ankara University</publisher-name>
                </publisher>
                    </journal-meta>
                <article-meta>
                                        <article-id pub-id-type="doi">10.33483/jfpau.1526554</article-id>
                                                                <article-categories>
                                            <subj-group  xml:lang="en">
                                                            <subject>Basic Pharmacology</subject>
                                                    </subj-group>
                                            <subj-group  xml:lang="tr">
                                                            <subject>Temel Farmakoloji</subject>
                                                    </subj-group>
                                    </article-categories>
                                                                                                                                                        <title-group>
                                                                                                                        <article-title>SJÖGREN SENDROMUNDA GÜNCEL İLAÇ TEDAVİSİ</article-title>
                                                                                                                                                                                                <trans-title-group xml:lang="en">
                                    <trans-title>CURRENT DRUG TREATMENT IN SJÖGREN’S SYNDROME</trans-title>
                                </trans-title-group>
                                                                                                    </title-group>
            
                                                    <contrib-group content-type="authors">
                                                                        <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0009-0007-9301-1946</contrib-id>
                                                                <name>
                                    <surname>Öztürk</surname>
                                    <given-names>Aybüke</given-names>
                                </name>
                                                                    <aff>ERCİYES ÜNİVERSİTESİ, ECZACILIK FAKÜLTESİ</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-7088-7490</contrib-id>
                                                                <name>
                                    <surname>Uzunhisarcıklı</surname>
                                    <given-names>Ebru</given-names>
                                </name>
                                                                    <aff>ERCİYES ÜNİVERSİTESİ, ECZACILIK FAKÜLTESİ, ECZACILIK MESLEK BİLİMLERİ BÖLÜMÜ, FARMAKOLOJİ ANABİLİM DALI</aff>
                                                            </contrib>
                                                                                </contrib-group>
                        
                                        <pub-date pub-type="pub" iso-8601-date="20250120">
                    <day>01</day>
                    <month>20</month>
                    <year>2025</year>
                </pub-date>
                                        <volume>49</volume>
                                        <issue>1</issue>
                                        <fpage>171</fpage>
                                        <lpage>183</lpage>
                        
                        <history>
                                    <date date-type="received" iso-8601-date="20240801">
                        <day>08</day>
                        <month>01</month>
                        <year>2024</year>
                    </date>
                                                    <date date-type="accepted" iso-8601-date="20241002">
                        <day>10</day>
                        <month>02</month>
                        <year>2024</year>
                    </date>
                            </history>
                                        <permissions>
                    <copyright-statement>Copyright © 1971, Journal of Faculty of Pharmacy of Ankara University</copyright-statement>
                    <copyright-year>1971</copyright-year>
                    <copyright-holder>Journal of Faculty of Pharmacy of Ankara University</copyright-holder>
                </permissions>
            
                                                                                                <abstract><p>Amaç: Bu derleme çalışmasında Sjögren (Sikka) sendromuna ilişkin bugüne kadar elde edilen bulgulara ve tedavi yöntemlerine odaklanılması amaçlanmıştır. Bu bağlamda Sjögren sendromunun epidemiyolojisi, klinik bulguları, tanı yöntemleri ve tedavisine yönelik, çoğunlukla gözlemsel, açık etiketli ve randomize klinik çalışmalardan elde edilen mevcut kanıtlar ile Pilokarpin ve Sevimelin gibi muskarinik agonistler, antimalaryaller (Hidroksiklorokin); Metotreksat, Leflunomid, Azatioprin, Sülfasalazin, Mikofenolik asit ve Siklosporin gibi geleneksel biyolojik olmayan hastalığı modifiye eden antiromatizmal ilaçlar (DMARD&#039;ler); ve aralarında alkilleyici ajan Siklofosfamid ve B hücrelerini hedef alan anti-CD20 antikoru Rituksimab&#039;ın da bulunduğu diğer güçlü ajanlardan bahsedilmiştir.Sonuç ve Tartışma: Hastalar, tanıyı doğrulamak ve hastalığın derecesini belirlemek için kapsamlı bir tedavi öncesi değerlendirmeye tabi tutulmalı ve buna göre terapötik yaşam tarzı değişiklikleri ile farmakolojik ajanlardan yararlanmalıdır. Orta ve şiddetli tutulumu olan hastalar genellikle klinik tabloya, dokulara ve etkilenen organ sistemine bağlı olarak immünsüpresiflerin ve biyolojik ajanların kullanımı da dahil olmak üzere sistemik tıbbi tedaviye ihtiyaç duymaktadırlar.</p></abstract>
                                                                                                                                    <trans-abstract xml:lang="en">
                            <p>Objective: In this review study, it is aimed to focus on the findings and treatment methods obtained to date regarding Sjögren&#039;s (Sikka) syndrome. In this context, the available evidence on the epidemiology, clinical findings, diagnostic methods and treatment of Sjögren&#039;s syndrome, mostly obtained from observational, open-label and randomized clinical studies, and muscarinic agonists such as Pilocarpine and Sevimelin, antimalarials (Hydroxychloroquine); traditional non-biological disease-modifying antirheumatic drugs (DMARDs) such as Methotrexate, Leflunomide, Azathioprine, Sulfasalazine, Mycophenolic acid and Cyclosporine; and other potent agents are mentioned, including the alkylating agent Cyclophosphamide and the B-cell-targeting anti-CD20 antibody Rituximab.Result and Discussion: Patients should undergo a comprehensive pre-treatment evaluation to confirm the diagnosis and determine the degree of the disease and benefit from therapeutic lifestyle changes and pharmacological agents accordingly. Patients with moderate to severe involvement generally require systemic medical treatment, including the use of immunosuppressants and biologic agents, depending on the clinical picture, tissues, and organ system affected.</p></trans-abstract>
                                                            
            
                                                            <kwd-group>
                                                    <kwd>Alkilleyici ajan</kwd>
                                                    <kwd>  DMARD</kwd>
                                                    <kwd>  muskarinik agonist</kwd>
                                                    <kwd>  Rituksimab</kwd>
                                            </kwd-group>
                                                        
                                                                            <kwd-group xml:lang="en">
                                                    <kwd>Alkylating agent</kwd>
                                                    <kwd>  DMARD</kwd>
                                                    <kwd>  muscarinic agonist</kwd>
                                                    <kwd>  Rituximab</kwd>
                                            </kwd-group>
                                                                                                            </article-meta>
    </front>
    <back>
                            <ref-list>
                                    <ref id="ref1">
                        <label>1</label>
                        <mixed-citation publication-type="journal">1.	Ramos-casals, M., Brito-zerón, P., Sisó-almirall, A., Bosch, X., Tzioufas, A.G. (2012). Topical and systemic medications for the treatment of primary Sjögren’s syndrome. Nature Reviews Rheumatology, 8(7), 399-411. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref2">
                        <label>2</label>
                        <mixed-citation publication-type="journal">2.	Manoussakis, M.N., Georgopoulou, C., Zintzaras, E., Spyropoulou, M., Stavropoulou, A., Skopouli, F.N., Moutsopoulos, H.M. (2004). Sjögren’s syndrome associated with systemic lupus erythematosus: Clinical and laboratory profiles and comparison with primary Sjögren’s syndrome. Arthritis &amp; Rheumatism, 50, 882-891. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref3">
                        <label>3</label>
                        <mixed-citation publication-type="journal">3.	Seror, R., Theander, E., Brun, J.G., Ramos-Casals, M., Valim, V., Dörner, T., Bowman, S.J. (2015). Validation of EULAR primary Sjögren’s syndrome disease activity (ESSDAI) and patient indexes (ESSPRI). Annals of the Rheumatic Diseases, 74, 859-866.</mixed-citation>
                    </ref>
                                    <ref id="ref4">
                        <label>4</label>
                        <mixed-citation publication-type="journal">4.	Qin, B., Wang, J., Yang, Z., Yang, M., Ma, N., Huang, F., Zhong, R. (2015). Epidemiology of primary sjögren’s syndrome: A systematic review and meta-analysis. Annals of the Rheumatic Diseases, 74, 1983-1989. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref5">
                        <label>5</label>
                        <mixed-citation publication-type="journal">5.	Kvarnstrom, M., Ottosson, V., Nordmark, B., Wahren-herlenius, M. (2015). Incident cases of primary sjögren’s syndrome during a 5-year period in stockholm county: A descriptive study of the patients and their characteristics. Scandinavian Journal of Rheumatology, 44, 135-142. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref6">
                        <label>6</label>
                        <mixed-citation publication-type="journal">6.	Weng, M.Y., Huang, Y.T., Liu, M.F., Lu, T.H. (2011). Incidence and mortality of treated primary Sjögren’s syndrome in taiwan: A population-based study. Journal of Rheumatology, 38, 706-708. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref7">
                        <label>7</label>
                        <mixed-citation publication-type="journal">7.	Baer, A.N., Maynard, J.W., Shaikh, F., Magder, L.S., Petri, M. (2010). Secondary Sjögren’s syndrome in systemic lupus erythematosus defines a distinct disease subset. Journal of Rheumatology, 37, 1143-1149.                   [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref8">
                        <label>8</label>
                        <mixed-citation publication-type="journal">8.	Carmona, L., González-álvaro, I., Balsa, A., Belmonte, M.A., Tena, X., Sanmartí, R., Gomez-reino, J.J. (2003). Rheumatoid arthritis in Spain: Occurrence of extra-articular manifestations and estimates of disease severity. Annals of the Rheumatic Diseases, 62, 897-900. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref9">
                        <label>9</label>
                        <mixed-citation publication-type="journal">9.	Avouac, J., Airò, P., Dieude, P., Caramaschi, P., Tiev, K., Diot, E., Matucci-cerinic, M. (2010). Associated autoimmune diseases in systemic sclerosis define a subset of patients with milder disease: Results from 2 large cohorts of European Caucasian patients. Journal of Rheumatology, 37, 608-614. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref10">
                        <label>10</label>
                        <mixed-citation publication-type="journal">10.	Tzioufas, A.G., Kapsogeorgou, E.K., Moutsopoulos, H.M. (2012). Pathogenesis of Sjögren’s syndrome: What we know and what we should learn. Journal of Autoimmunity, 39, 4-8. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref11">
                        <label>11</label>
                        <mixed-citation publication-type="journal">11.	Hillen, M.R., Ververs, F.A., Kruize, A.A., Van roon, J.A. (2014). Dendritic cells, t-cells and epithelial cells: A crucial interplay in immunopathology of primary Sjögren’s syndrome. Expert Review of Clinical Immunology, 10, 521-531. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref12">
                        <label>12</label>
                        <mixed-citation publication-type="journal">12.	Albrecht, J., Berlin, J.A., Braverman, I.M., Chrousos, G.P., Garrido, M.C., Marques, G. (2006). Skin involvement and outcome measures in systemic autoimmune diseases. Clinical and Experimental Rheumatology, 24(41), 52-59.</mixed-citation>
                    </ref>
                                    <ref id="ref13">
                        <label>13</label>
                        <mixed-citation publication-type="journal">13.	Ramos-casals, M., Brito-zerón, P., Seror, R., Bootsma, H., Bowman, S.J., Dörner, T., Tzioufas, A. (2015). Characterization of systemic disease in primary Sjögren’s syndrome: EULAR-SS task force recommendations for articular, cutaneous, pulmonary and renal involvements. Rheumatology. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref14">
                        <label>14</label>
                        <mixed-citation publication-type="journal">14.	Zero, D.T., Brennan, M.T., Daniels, T.E., Papas, A., Stewart, C., Pinto, A., Hammitt, K.M (2016). Clinical practice guidelines for oral management of Sjögren disease: Dental caries prevention. The Journal of the American Dental Association (JADA), 147, 295-305. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref15">
                        <label>15</label>
                        <mixed-citation publication-type="journal">15.	Gottenberg, J.E., Ravaud, P., Puéchal, X., Le guern, V., Sibilia, J., Goeb, V., Mariette, X. (2014). Effects of hydroxychloroquine on symptomatic improvement in primary Sjögren syndrome. Jama, 312(3), 249. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref16">
                        <label>16</label>
                        <mixed-citation publication-type="journal">16.	Steinfeld, S.D., Tant, L., Burmester, G.R., Teoh, N.K., Wegener, W.A., Goldenberg, D.M., Pradier, O. (2006). Epratuzumab (humanised anti-cd22 antibody) in primary Sjögren’s syndrome: An open-label phase I/II study. Arthritis Research &amp; Therapy, 8, 1-11. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref17">
                        <label>17</label>
                        <mixed-citation publication-type="journal">17.	Adler, S., Körner, M., Förger, F., Huscher, D., Caversaccio, M.D., Villiger, P.M. (2013). Evaluation of histological, serological and clinical changes in response to abatacept treatment of primary Sjögren’s syndrome: A pilot study. Arthritis Care &amp; Research, 65(11), 1862-1868. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref18">
                        <label>18</label>
                        <mixed-citation publication-type="journal">18.	Rummel, M.J., Niederle, N., Maschmeyer, G., Banat, G.A., von Grünhagen, U., Losem, C., Brugger, W. (2013). Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: An open-label, multicentre, randomised, phase 3 non-inferiority trial. The Lancet, 381, 1203-1210. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref19">
                        <label>19</label>
                        <mixed-citation publication-type="journal">19.	Voulgarelis, M., Giannouli, S., Tzioufas, A.G., Moutsopoulos, H.M. (2006). Long term remission of sjögren’s syndrome associated aggressive B cell non-hodgkin’s lymphomas following combined B cell depletion therapy and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). Annals of the Rheumatic Diseases, 65(8), 1033-1037. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref20">
                        <label>20</label>
                        <mixed-citation publication-type="journal">20.	Aragona, P. (2002). Sodium hyaluronate eye drops of different osmolarity for the treatment of dry eye in Sjogren’s syndrome patients. British Journal of Ophthalmology, 86(8), 879-884. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref21">
                        <label>21</label>
                        <mixed-citation publication-type="journal">21.	Mcdonald, C.C., Kaye, S.B., Figueiredo, F.C., Macintosh, G., Lockett, C. (2002). A randomised, crossover, multicentre study to compare the performance of 0.1% (w/v) sodium hyaluronate with 1.4% (w/v) polyvinyl alcohol in the alleviation of symptoms associated with dry eye syndrome. Eye, 16(5), 601-607. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref22">
                        <label>22</label>
                        <mixed-citation publication-type="journal">22.	Aragona, P., Benítez-del-castillo, J.M., Coroneo, M.T., Mukherji, S., Tan, J., Vandewalle, E., Simmons, P.A. (2020). Safety and efficacy of a preservative-free artificial tear containing carboxymethylcellulose and hyaluronic acid for dry eye disease: A randomized, controlled, multicenter 3-month study. Clinical Ophthalmology, volume 14, 2951-2963. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref23">
                        <label>23</label>
                        <mixed-citation publication-type="journal">23.	Sullivan, D.A., Dana, R., Sullivan, R.M., Krenzer, K.L., Sahin, A., Arica, B., Cermak, J.M. (2018). Meibomian gland dysfunction in primary and secondary Sjögren syndrome. Ophthalmic Research, 59(4), 193-205. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref24">
                        <label>24</label>
                        <mixed-citation publication-type="journal">24.	Holland, E.J., Luchs, J., Karpecki, P.M., Nichols, K.K., Jackson, M.A., Sall, K., Tauber, J., Roy, M., Raychaudhuri, A., Shojaei, A. (2017). Lifitegrast for the treatment of dry eye disease: Results of a phase III, randomized, double-masked, placebo-controlled trial (OPUS-3). Ophthalmology, 124(1), 53-60. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref25">
                        <label>25</label>
                        <mixed-citation publication-type="journal">25.	Foulks, G.N. (2008). Treatment of dry eye disease by the non-ophthalmologist. Rheumatic Disease Clinics of North America, 34(4), 987-1000. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref26">
                        <label>26</label>
                        <mixed-citation publication-type="journal">26.	Sall, K., Stevenson, O.D., Mundorf, T.K., Reis, B.L. (2000). Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease11reprint requests to: Linda lewis, 575 anton blvd, suite 900, costa mesa, CA 92626. Ophthalmology, 107(4), 631-639. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref27">
                        <label>27</label>
                        <mixed-citation publication-type="journal">27.	Hauswirth, S.G., Kabat, A.G., Hemphill, M., Somaiya, K., Hendrix, L.H., Gibson, A.A. (2023). Safety, adherence and discontinuation in varenicline solution nasal spray clinical trials for dry eye disease. Journal of Comparative Effectiveness Research, (12), (6). [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref28">
                        <label>28</label>
                        <mixed-citation publication-type="journal">28.	Vijmasi, T., Chen, F.Y.T., Balasubbu, S., Gallup, M., Mckown, R.L., Laurie, G.W., Mcnamara, N.A. (2014). Topical administration of lacritin is a novel therapy for aqueous-deficient dry eye disease. Investigative Opthalmology and Visual Science, 55(8), 5401. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref29">
                        <label>29</label>
                        <mixed-citation publication-type="journal">29.	Sosne, G., Dunn, S.P., Kim, C. (2015). Thymosin β4 significantly improves signs and symptoms of severe dry eye in a phase 2 randomized trial. Cornea, 34(5), 491-496. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref30">
                        <label>30</label>
                        <mixed-citation publication-type="journal">30.	Wu, A.J. (2008). Optimizing dry mouth treatment for individuals with Sjögren&#039;s syndrome. Rheumatic Disease Clinics of North America, 34(4), 1001-1010. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref31">
                        <label>31</label>
                        <mixed-citation publication-type="journal">31.	Salum, F.G., Medella-junior, F. De A.C., Figueiredo, M.A.Z., Cherubini, K. (2018). Salivary hypofunction: An update on therapeutic strategies. Gerodontology. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref32">
                        <label>32</label>
                        <mixed-citation publication-type="journal">32.	Papas, A.S., Sherrer, Y.S., Charney, M., Golden, H.E., Medsger, T.A., Walsh, B.T., Gallagher, S.C. (2004). Successful treatment of dry mouth and dry eye symptoms in Sjögren&#039;s syndrome patients with oral pilocarpine: A randomized, placebo-controlled, dose-adjustment study. JCR: Journal of Clinical Rheumatology, 10(4), 169-177. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref33">
                        <label>33</label>
                        <mixed-citation publication-type="journal">33.	Fife, R.S., Chase, W.F., Dore, R.K., Wiesenhutter, C.W., Lockhart, P.B., Tindall, E., Suen, J.Y. (2002). Sevimelin for the treatment of xerostomia in patients with Sjögren syndrome. Archives of Internal Medicine, 162(11), 1293. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref34">
                        <label>34</label>
                        <mixed-citation publication-type="journal">34.	Tsifetaki, N. (2003). Oral pilocarpine for the treatment of ocular symptoms in patients with Sjogren’s syndrome: A randomised 12 week controlled study. Annals of the Rheumatic Diseases, 62(12), 1204-1207. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref35">
                        <label>35</label>
                        <mixed-citation publication-type="journal">35.	Petrone, D., Condemi, J.J., Fife, R., Gluck, O., Cohen, S., Dalgin, P. (2002). A double-blind, randomized, placebo-controlled study of Sevimelin in Sjögren’s syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis and Rheumatism, 46(3), 748-754. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref36">
                        <label>36</label>
                        <mixed-citation publication-type="journal">36.	Hendrickson, R.G., Morocco, A.P., Greenberg, M.I. (2004). Pilocarpine toxicity and the treatment of xerostomia. The Journal of Emergency Medicine, 26(4), 429-432. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref37">
                        <label>37</label>
                        <mixed-citation publication-type="journal">37.	Carsons, S.E., Vivino, F.B., Parke, A., Carteron, N., Sankar, V., Brasington, R., Mandel, S. (2017). Treatment guidelines for rheumatologic manifestations of Sjögren&#039;s syndrome: Use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain. Arthritis Care and Research, 69(4), 517-527. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref38">
                        <label>38</label>
                        <mixed-citation publication-type="journal">38.	Gheitasi, H., Kostov, B., Solans, R., Fraile, G., Suárez-Cuervo, C., Casanovas, A., Brito-zerón, P. (2015). How are we treating our systemic patients with primary Sjögren syndrome? Analysis of 1120 patients. International Immunopharmacology, 27(2), 194-199. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref39">
                        <label>39</label>
                        <mixed-citation publication-type="journal">39.	Hoes, J.N., Van der goes, M.C., Van raalte, D.H., Van der Zijl, N.J., Den Uyl, D., Lems, W.F., Bijlsma, J.W.J. (2011). Glucose tolerance, insulin sensitivity and β-cell function in patients with rheumatoid arthritis treated with or without low-to-medium dose glucocorticoids. Annals of the Rheumatic Diseases, 70(11), 1887-1894.  [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref40">
                        <label>40</label>
                        <mixed-citation publication-type="journal">40.	Skopouli, F.N., Jagiello, P., Tsifetaki, N., Moutsopoulos, H.M. (1996). Methotrexate in primary Sjögren&#039;s syndrome. Clinical and Experimental Rheumatology, 14(5), 555-558.</mixed-citation>
                    </ref>
                                    <ref id="ref41">
                        <label>41</label>
                        <mixed-citation publication-type="journal">41.	Price, E.J., Rigby, S.P., Clancy, U., Venables, P.J. (1998). A double-blind placebo-controlled trial of azathioprine in the treatment of primary Sjögren&#039;s syndrome. Journal of Rheumatology, 25(5), 896.</mixed-citation>
                    </ref>
                                    <ref id="ref42">
                        <label>42</label>
                        <mixed-citation publication-type="journal">42.	Van Woerkom, J.M., Kruize, A.A., Geenen, R., Van Roon, E.N., Goldschmeding, R., Verstappen, S.M. M., Bijlsma, J.W.J. (2007). Safety and efficacy of leflunomide in primary sjogren’s syndrome: A phase II pilot study. Annals of the Rheumatic Diseases, 66(8), 1026-1032. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref43">
                        <label>43</label>
                        <mixed-citation publication-type="journal">43.	Van der Heijden, E.H.M., Blokland, S.L.M., Hillen, M.R., Lopes, A.P.P., van Vliet-Moret, F.M., Rosenberg, A.J.W.P., van Roon, J.A.G. (2020). Leflunomide-hydroxychloroquine combination therapy in patients with primary Sjögren&#039;s syndrome (repurpss-i): A placebo-controlled, double-blinded, randomised clinical trial. Rheumatology Department, University Medical Center Utrecht, Utrecht, Netherlands.</mixed-citation>
                    </ref>
                                    <ref id="ref44">
                        <label>44</label>
                        <mixed-citation publication-type="journal">44.	Drosos, A.A., Skopouli, F.N., Costopoulos, J.S., Papadimitriou, C.S., Moutsopoulos, H.M. (1986). Cyclosporin A (cya) in primary Sjogren’s syndrome: A double blind study. Annals of the Rheumatic Diseases, 45(9), 732-735. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref45">
                        <label>45</label>
                        <mixed-citation publication-type="journal">45.	Devauchelle-pensec, V., Mariette, X., Jousse-joulin, S., Berthelot, J.M., Perdriger, A., Puéchal, X., Saraux, A. (2014). Treatment of primary Sjögren syndrome with rituximab. Annals of Internal Medicine, 160(4), 233-242. [CrossRef]</mixed-citation>
                    </ref>
                                    <ref id="ref46">
                        <label>46</label>
                        <mixed-citation publication-type="journal">46.	Faustman, D.L., Vivino, F.B., Carsons, S.E. (2014). Treatment of primary Sjögren syndrome with rituximab. Annals of Internal Medicine, 161(5), 376. [CrossRef]</mixed-citation>
                    </ref>
                            </ref-list>
                    </back>
    </article>
