title: Brief Report: Ultrasonographic Assessment of Salivary Gland Response to Rituximab in Primary Sjögren's Syndrome.
abstract: OBJECTIVE
  To evaluate changes in salivary gland echostructure and vascularization after rituximab treatment in patients with primary Sjögren's syndrome (SS).
  
  
  METHODS
  Twenty-eight patients with primary SS included in the multicenter, randomized, double-blind, placebo-controlled Tolerance and Efficacy of Rituximab in Primary Sjögren's Syndrome (TEARS) trial underwent salivary gland ultrasonography before the first placebo or rituximab infusion and then 6 months later. Trial inclusion criteria were scores of ≥50 mm on at least 2 of 4 visual analog scales (VAS) evaluating dryness, pain, fatigue, and global disease; and recent-onset (<10 years) biologically active primary SS and/or systemic primary SS. Patients were randomly assigned (1:1) to rituximab (1 gm at weeks 0 and 2) or placebo. Ultrasonography of both parotid and submandibular glands was performed to assess echostructure (using a semiquantitative score of 0-4, with improvement defined as a ≥1-point decrease), size of each gland, and vascularization based on the resistive index of the transverse facial artery of the parotid gland before and after lemon juice stimulation.
  
  
  RESULTS
  Of the 28 patients, 5 (18%; 3 in the placebo group and 2 in the rituximab group) had clinically detectable bilateral parotid gland enlargement at baseline. Parotid parenchyma echostructure improved in 50% of the rituximab-treated patients versus 7% of the placebo-treated patients (P = 0.03). In the submandibular glands, echostructure also improved in a larger proportion of rituximab-treated patients, although the difference was not significant (36% versus 7% of placebo-treated patients; P = 0.16). Gland sizes and resistive index remained unchanged.
  
  
  CONCLUSIONS
  Ultrasonography showed improved salivary gland echostructure in patients with primary SS receiving rituximab, with no changes in salivary gland size or vascularization, 6 months after the first infusion.
authors.affiliation: CHU de la Cavale Blanche and EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.affiliation: CHU de la Cavale Blanche and EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
authors.affiliation: CHU de la Cavale Blanche and EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Divi
authors.initials: D
authors.lastname: Cornec
authors.affiliation: CHU de la Cavale Blanche Brest, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Marhadour
authors.affiliation: CHU de la Cavale Blanche Brest, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Bressollette
authors.affiliation: CHU de la Cavale Blanche Brest, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Gestin
authors.affiliation: EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Jacques Olivier
authors.initials: JO
authors.lastname: Pers
authors.affiliation: INSERM CIC 0502, CHU de la Cavale Blanche, Brest, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nowak
authors.affiliation: CHU de la Cavale Blanche and EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010306:Parotid Gland / Q000098:blood supply / Q000000981:diagnostic imaging*; D000069283:Rituximab; D012859:Sjogren's Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013363:Submandibular Gland / Q000098:blood supply / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab