Oral Diseases (2012) doi:10.1111/j.1601-0825.2012.01932.x Biologic therapy has a 
potential to benefit patients with orofacial manifestations of Sjogren syndrome 
(SS). The most appropriate use of biologics would appear to be in patients with 
severe or multisystem features of SS, but their use early in the pathogenesis 
has the potential to prevent disease progression. Tumour necrosis factor-alpha 
blockade has not proven effective in SS. B-cell depletion using rituximab has 
been of benefit, mainly in relation to extraglandular features, and to some 
extent in relation to hyposalivation where there is still residual salivary 
function. Rituximab is also effective in the treatment of SS-associated 
(extrasalivary) lymphomas, although the therapeutic response in salivary 
lymphoma is poorer. Rituximab is given as a single or periodic intravenous 
infusion. Potential adverse effects exist, notably infusion reactions and 
infection, and so a full risk/benefit analysis is indicated for prospective 
patients. This and clinical use is best performed and monitored in conjunction 
with rheumatologists with appropriate training and experience in biologic 
therapies. Further studies of rituximab in SS are ongoing, and newer agents 
under trial include belimumab.