Does Xiidra Work for Sjögren's? A Comprehensive Analysis

October 9, 2025 •

3 min read

Sjögren's syndrome is a chronic autoimmune disease affecting the body's moisture-producing glands. While not officially FDA-approved for Sjögren's itself, the question of 'Does Xiidra work for Sjögren's?' is critical for patients experiencing severe dry eye, a primary symptom of the condition.

Quick Summary

Xiidra (lifitegrast) is a prescription eye drop used to treat the signs and symptoms of dry eye disease. It is often prescribed off-label to manage the severe dry eye associated with Sjögren's syndrome by targeting underlying inflammation.

Key Points

Off-Label Use: Xiidra is not FDA-approved specifically for Sjögren's syndrome but is often prescribed off-label to treat its primary symptom, dry eye disease.
Inflammation Target: Xiidra works by blocking a protein (LFA-1) that is key to the inflammatory cycle on the eye's surface, reducing the root cause of dry eye symptoms.
Patient-Reported Efficacy: In a community of Sjögren's patients, lifitegrast (Xiidra) was ranked as a highly effective treatment, with a large majority reporting positive results.
Rapid Onset: Unlike some other prescription eye drops that can take months to work, some patients experience symptom relief with Xiidra in as little as two weeks.
Key Side Effects: The most common side effects are temporary eye irritation upon use and an unusual metallic taste in the mouth (dysgeusia).
Treatment Comparison: Xiidra targets inflammation directly, whereas medications like Restasis/Cequa modulate the immune system to increase tear production over time, and artificial tears only provide lubrication.
Dosage: The standard dose is one drop in each eye twice daily, approximately 12 hours apart, from a single-use vial.

Understanding Sjögren's Syndrome and its Impact on Eye Health

Sjögren's syndrome is a systemic autoimmune disorder where the immune system mistakenly attacks its own moisture-producing glands, primarily the lacrimal (tear) and salivary (saliva) glands. This leads to profound dry eye and dry mouth. Dry eye in Sjögren's can cause a gritty or burning sensation, blurred vision, light sensitivity, and increase the risk of eye infections and corneal damage. The disease can also affect other parts of the body, including joints, skin, lungs, and kidneys, and cause fatigue.

What is Xiidra and How Does It Work?

Xiidra (lifitegrast) is a prescription ophthalmic solution approved by the FDA in 2016 for dry eye disease. It targets inflammation associated with DED, unlike artificial tears which provide temporary lubrication.

The Mechanism of Action

Inflammation on the eye's surface is often the cause of DED. Xiidra works by blocking the interaction between LFA-1 on T-cells and ICAM-1 on the eye's surface. This action reduces inflammation and interrupts the cycle causing dry eye symptoms.

Xiidra's Efficacy for Sjögren's-Related Dry Eye

While not specifically FDA-approved for Sjögren's, Xiidra is often used off-label for Sjögren's-related dry eye due to its anti-inflammatory mechanism. Patient data and clinical experience support this use, with many Sjögren's patients reporting positive results. Studies indicate that lifitegrast can improve symptoms and signs of DED, with some patients noticing relief within two weeks. A review showed decreased use of other DED treatments after starting lifitegrast.

Comparison of Dry Eye Treatments for Sjögren's

Several treatment options are available for Sjögren's-related dry eye, depending on severity and insurance coverage.


Treatment	Active Ingredient	Mechanism of Action	Onset of Action	Key Considerations
Xiidra	Lifitegrast	LFA-1 antagonist; blocks T-cell activation and inflammation.	Can be as fast as 2 weeks.	Common side effects include taste alteration (dysgeusia) and eye irritation. Not a lubricant.
Restasis / Cequa	Cyclosporine	Calcineurin inhibitor; acts as an immunomodulator to increase tear production.	May take 3-6 months for full effect.	Main side effect is often a burning sensation upon instillation. Cequa has a higher concentration than Restasis.
Artificial Tears	Various lubricants (e.g., polyethylene glycol, propylene glycol)	Provides temporary surface lubrication and moisture.	Immediate but temporary relief.	Must be applied frequently. Preservative-free options are recommended for frequent use to avoid further irritation.
Punctal Plugs	Silicone or Collagen	Blocks tear drainage to keep tears on the eye's surface longer.	Immediate upon insertion.	A minor in-office procedure. Plugs can sometimes fall out or cause irritation.

Dosage, Side Effects, and Administration

The recommended dosage for Xiidra is one drop in each eye twice daily, about 12 hours apart. It comes in preservative-free, single-use vials.

Common Side Effects:

Instillation site irritation (burning or stinging).
Dysgeusia (unusual or metallic taste).
Blurred vision (often temporary).
Eye redness, headache, or increased tearing.

Serious allergic reactions are rare but require immediate medical attention.

Conclusion

For managing inflammatory dry eye in Sjögren's, Xiidra appears to be an effective option based on evidence and clinical use. Its mechanism targeting inflammation offers a different approach than simple lubrication. While not a cure for Sjögren's, it can improve quality of life by reducing dry eye signs and symptoms. Consulting with a rheumatologist or ophthalmologist is crucial to determine if Xiidra is suitable for an individual's treatment.

For more information from a leading patient advocacy group, you can visit the Sjögren's Foundation.

Frequently Asked Questions

No, Xiidra is not officially approved to treat Sjögren's syndrome itself. It is FDA-approved to treat the signs and symptoms of dry eye disease, which is a major component of Sjögren's. Doctors may prescribe it off-label for this purpose.

While individual results vary, some clinical studies have shown that Xiidra can begin to reduce symptoms of eye dryness in as little as two weeks, with continued improvement over 6 and 12 weeks.

The most common side effects reported in clinical trials were instillation-site irritation (stinging or burning when you put the drops in), dysgeusia (an unusual or metallic taste), and reduced visual acuity (temporary blurred vision).

Yes, but you should wait at least 10 minutes between using Xiidra and any other eye drops. If you wear contact lenses, you should remove them before using Xiidra and wait 15 minutes before reinserting them.

Xiidra (lifitegrast) and Restasis (cyclosporine) work differently. Xiidra blocks the LFA-1/ICAM-1 interaction to stop T-cell mediated inflammation. Restasis is an immunomodulator that is believed to help your eyes increase their own tear production. Xiidra may also have a faster onset of action for some patients.

If you miss a dose, you should instill it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and resume your normal schedule. Do not use extra medicine to make up the missed dose.

No, dry mouth was not reported as a side effect in clinical studies of Xiidra. The most common side effect related to the mouth is a strange or metallic taste, known as dysgeusia.