Comparative efficacy and safety of topical therapies for ocular involvement in Sjögren's syndrome: a systematic review and network meta-analysis.

OBJECTIVE: To compare the efficacy and safety of topical ocular therapies for Sjögren's syndrome-related dry eye disease. METHODS: PubMed, Embase, Web of Science, Cochrane Central, CNKI, Wanfang, VIP, and CBM were searched from inception to April 29, 2026. Randomized controlled trials of topical ocular therapies were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. A frequentist network meta-analysis was conducted in Stata 17.0. Treatment ranking was estimated using SUCRA. RESULTS: Twelve RCTs were included. For ocular staining score, platelet-rich plasma eye drops showed a favorable effect compared with control (SMD -6.96 [95% CI -9.76, -4.16]), and autologous serum also demonstrated a favorable effect. For tear break-up time, autologous serum and platelet-rich plasma showed relatively favorable improvements compared with control (MD 3.90 [95% CI 2.24, 5.56] and MD 3.85 [95% CI 1.48, 6.22], respectively). For Schirmer test, cyclosporine A was associated with improved tear secretion compared with control (MD 5.29 [95% CI 3.80, 6.78]). For Ocular Surface Disease Index, cyclosporine A plus diquafosol sodium showed improvement compared with control (MD -2.40 [95% CI -3.21, -1.59]). Tacrolimus was associated with a higher risk of adverse events than control (OR 2.12 [95% CI 1.01, 4.42]). The certainty of evidence was generally low to moderate, and these findings should be interpreted cautiously because of sparse networks, limited direct comparisons, and uncertainty in treatment ranking. CONCLUSION: Topical ocular therapies showed outcome-specific advantages. Platelet-rich plasma, autologous serum, and cyclosporine A may benefit ocular surface damage, tear film stability, and tear secretion, respectively. However, sparse networks, local inconsistency, and incomplete safety reporting warrant cautious interpretation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261379380.