Preventive effects of early immunosuppressive treatment on the development of interstitial lung disease in systemic sclerosis
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Hypothesizing that early treatment yields improved prognosis, we aimed to investigate how the timing of immunosuppressive treatment relates to interstitial lung disease (ILD) development and the course of pulmonary function in systemic sclerosis (SSc). METHODS: A cohort was created using data from the EUSTAR database and Nijmegen Systemic Sclerosis cohort, including adult patients who started their first immunosuppressive treatment (i.e. mycophenolate mofetil, methotrexate, cyclophosphamide, tocilizumab or rituximab) after SSc diagnosis, and no signs of ILD on high-resolution CT. ILD-free survival and the course of forced vital capacity (FVC) % predicted were assessed for up to 5 years' follow-up comparing patients who started early (disease duration ≤3 years) vs late with immunosuppression. RESULTS: 1052 patients met the eligibility criteria. The early treatment group (n = 547, 52%) showed a higher prevalence of male sex, diffuse cutaneous subtype (53.1% vs 36.5%), and anti-topoisomerase-I antibody (ATA, 51.1% vs 42.7%). Most patients were treated with methotrexate (60.1%), whereas only a few patients were treated with biologics (1.7%). The incidence of ILD was 46.6% after mean (s.d.) 3.6 (1.4) years; the hazards ratio for ILD in the early treatment group was 1.13 (95% CI: 0.93, 1.38) after adjustment for confounders. FVC % predicted trajectories were comparable between groups. CONCLUSION: Our findings did not confirm a preventive role of early initiation of immunosuppressive therapy vs late initiation on ILD development. However, our findings should be interpreted with caution, considering the high inflammatory, ATA-positive enriched nature of the cohort, confounding by indication, and that very few patients were treated with biologics.
Source: Rheumatology
Authors: Arthiha Velauthapillai, M F R Bootsma, Cosimo Bruni, Christina Bergmann, Marco Matucci-Cerinic, David Launay, Gabriela Riemekasten, L Garzanova, Paolo Airò, Elena Rezus, Jose A P da Silva, Francesco Del Galdo, Nicolas Hunzelmann, Lorinda S Chung, Dorota Krasowska, Oliver Distler, Cornelia H M van den Ende, Madelon C Vonk, EUSTAR Collaborators, Serena Guiducci, Ulrich Walker, Florenzo Iannone, Oliver Distler, Radim Becvar, Maurizio Cutolo, Simona Rednic, Yannick Allanore, C Montecucco, Murat Inanc, Patricia E Carreira, László Czirják, Michele Iudici, Przemyslaw Kotyla, Elisabetta Zanatta, Katja Perdan-Pirkmajer, Gianluca Moroncini, Paolo Airò, Alexandra Balbir-Gurman, Nicolas Hunzelmann, Luca Idolazzi, Josko Mitrovic, Christopher Denton, Madelon Vonk, Jelena Colic, Jörg Henes, Ivan Foeldvari, José António Pereira da Silva, Bojana Stamenkovic, Maria De Santis, Lidia P Ananieva, Ulf Müller-Ladner, Gabriella Szücs, David Launay, Valeria Riccieri, Andra Balanescu, Ana Maria Gheorghiu, Christina Bergmann, Luc Mouthon, Vanessa Smith, Francesco Paolo Cantatore, Mette Mogensen, Marie Vanthuyne, Juan Jose Alegre-Sancho, Branimir Anić, Alberto Cauli, Kamal Solanki, Edoardo Rosato, Rosario Foti, Britta Maurer, Patricia Senet, Emmanuel Chatelus, Ira Litinsky, Francesco Del Galdo, Ivan Castellví, Massimiliano Limonta, Antonella Marcoccia, Thierry Martin, Anna Wojteczek, Gabriela Riemekasten, Elena Rezus, Giovanna Cuomo, Oscar Massimiliano Epis, Petros Sfikakis, Daniel Furst, Ana-Maria Ramazan, Jeska de Vries-Bouwstra, Marie-Elise Truchetet, Alain Lescoat, Marco Matucci-Cerinic, Julia Spierings, Masataka Kuwana, Mickaël Martin, Carmen-Pilar Simeón-Aznar, Magda Pârvu, Gonçalo Boleto, Nicoletta Del Papa, Kastriot Kastrati, Enrico Selvi, Marija Geroldinger-Simic, Marta Mosca, Marta Dzhus, Duygu Temiz Karadag, Anastas Batalov, Knarik Ginosyan, Vahan Mukuchyan, Valentina Vardanyan, Armine Haroyan, Mohammad Naffaa, Cristina Maglio, Cristiana Isabel Sieiro Santos, Futoshi Iwata, Monique Hinchcliff, Ana Cordeiro, Roberto Giacomelli, Francesco Benvenuti, Esther Vicente Rabaneda, Andrea-Hermina Györfi, Lilian Maria Lopez Nuñez, Rossella De Angelis, Jorge Alejandro Brigante, Yasser Miedany, Lijun Zhang
Institutions: Radboud University Medical Center, University of Zurich, University Hospital Zurich, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, IRCCS San Raffaele Roma, Université de Lille, Centre Hospitalier Universitaire de Lille, University of Lübeck, Association of Rheumatologists of Russia, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Grigore T. Popa University of Medicine and Pharmacy, Unidade Local de Saúde de Coimbra, University of Coimbra, University of Leeds, University of Cologne, VA Palo Alto Health Care System, Stanford University, Medical University of Lublin, Lille Inflammation Research International Center, University Hospital Schleswig-Holstein
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,679
OpenAlex ID: W4400877239