Which class of medication is best utilized for symptomatic treatment of mild to moderate Sjögren syndrome?

The best class of medication for symptomatic treatment of mild to moderate Sjögren syndrome is muscarinic agonists. This condition often presents with symptoms related to dryness due to decreased lacrimal (tear) and salivary gland secretion. Muscarinic agonists, such as pilocarpine and cevimeline, work by stimulating the muscarinic receptors in the exocrine glands, thereby enhancing secretion of saliva and tears. This effectively alleviates the symptoms of xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes) commonly experienced by patients with Sjögren syndrome.

Antihistamines tend to have anticholinergic properties, which can further exacerbate dryness rather than alleviate it. Systemic corticosteroids are typically used for more severe cases of Sjögren syndrome or when systemic complications arise, but they do not specifically target the dryness symptoms associated with this condition. Immunomodulators are generally reserved for severe manifestations or extra-glandular symptoms and are not first-line treatments for symptomatic relief in mild to moderate Sjögren syndrome.