On May 25, 2024, the Academic Annual Meeting of the Rheumatology and Immunology Medication Expert Committee of the Guangdong Pharmaceutical Society was held in Guangzhou. At the meeting, the "Chinese Clinical Practice Guidelines for Super Drug Instructions for Dry Syndrome (2023 Edition)" (hereinafter referred to as the "Guidelines") was officially released, marking the first domestic super drug instruction guide for dry syndrome.
It was reported at the meeting that the "Guidelines," led by Dr. Dai Lie, Director of the Rheumatology and Immunology Department, and Dr. Wu Junyan, Director of the Pharmacy Department at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, brought together the collective wisdom of domestic experts in rheumatology, immunology, ophthalmology, dentistry, and obstetrics. The "Guidelines," authored by Dr. Mo Yingqian, Deputy Director of the Rheumatology and Immunology Department at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, were published in the 43rd issue of the "Chinese Medical Journal" in 2023, providing rational medication guidance for clinical physicians and serving as a reference for pharmacy departments.
The incidence of dry syndrome in China is estimated to be (6-12)/100,000 people, with a prevalence of (16-339)/100,000 people, suggesting that the number of dry syndrome patients in China may exceed 4.5 million. Dry syndrome is one of the most common systemic autoimmune diseases in clinical practice of rheumatology and immunology, requiring long-term medication. However, currently used drugs for treating dry syndrome in clinical practice, such as steroids, hydroxychloroquine, and methotrexate, are considered "old drugs" in rheumatology and immunology, and none of them are indicated for dry syndrome in domestic drug instructions.
"The 'Guidelines' break down barriers between different departments, allowing rheumatology and immunology, ophthalmology, dentistry, obstetrics physicians, as well as clinical pharmacists from various medical institutions, to refer to and use them," said Dr. Mo Yingqian. The development of medications for dry syndrome in clinical treatment lags behind other common connective tissue diseases like rheumatoid arthritis and systemic lupus erythematosus. Currently, the treatment of dry syndrome is divided into two categories: local treatment and systemic medication. Local treatment includes eye preparations for dry syndrome-related dry keratoconjunctivitis, saliva stimulants, and artificial saliva. Systemic medication includes drugs that promote gland secretion and treat systemic symptoms and other affected systems.
Since the release of the first super drug consensus in China in 2010, the Guangdong Pharmaceutical Society has made significant explorations in the standardized management of super drug instructions. Wang Yong, Director of the Academic Department of the Guangdong Pharmaceutical Society, stated that Chinese clinical physicians often prescribe "old drugs" in rheumatology and immunology, such as glucocorticoids, hydroxychloroquine, and methotrexate, for dry syndrome patients, but none of these drugs are indicated for dry syndrome in domestic drug instructions. In addition to super-indicative drug use, the "Guidelines" also provide one recommendation for drug dosage and specific populations that are currently not included in the drug instructions. Therefore, more evidence from evidence-based medicine is needed to support the use of super drug instructions for dry syndrome, in order to better grasp the scope of application, strengthen medication monitoring, and prevent adverse drug events.
According to the introduction, in addition to referencing publicly available guidelines, consensus, and case series, the "Guidelines" also re-evaluate randomized controlled trials of "old drugs" in rheumatology and immunology for treating dry syndrome, design corresponding clinical questions, conduct evidence retrieval based on population, intervention, comparison, and outcome principles, synthesize meta-analyses, and grade recommendations, formulate and evaluate methods, ultimately forming 21 recommendations for 12 clinical questions, including 2 strong recommendations, 14 weak recommendations, and 5 consensus-based recommendations.
Zhu Jianhong, Deputy Chief Pharmacist of the Pharmacy Department at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, introduced that the medication regimens recommended in the "Guidelines" include domestically developed and marketed drugs such as Elamod and herbal medicines (such as total glucosides of paeony), as well as two traditional Chinese medicines, which are more in line with clinical practices in China and more suitable for dry syndrome patients in China. In addition, the "Guidelines" innovatively recommend drug treatment plans for different types of patients. Each recommendation in the "Guidelines" not only provides evidence quality ratings and expert recommendation strengths but also includes operational key points, making clinical application more standardized.
