Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis
Year: 2024
Type: article
Abstract: BACKGROUND AND AIMS: Systemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments. METHODS: We used data from a national multicentric prospective study using the French SSc national database. We estimated the average treatment effect (ATE) of sildenafil, bosentan, angiotensin-converting enzyme (ACE) inhibitors and iloprost on diastolic dysfunction, altered ejection fraction <50% and pulmonary arterial hypertension (PAH) using a causal method, namely the longitudinal targeted minimum loss-based estimation, to adjust for confounding and informative censoring. RESULTS: We included 1048 patients with available data regarding treatment. Regarding sildenafil analyses, the ATE on diastolic dysfunction at 3 years was -2.83% (95% CI -4.06; -1.60, p<0.00001), and the estimated ATE on altered ejection fraction <50% was -0.88% (95% CI -1.70; -0.05, p=0.037). We did not find a significative effect on PAH. Regarding bosentan, ACE inhibitors and iloprost, none of them neither showed a significant effect on diastolic dysfunction, altered ejection fraction <50% or PAH. CONCLUSIONS: Using causal methods, our study is the first and largest suggesting that sildenafil might have benefits among SSc patients regarding diastolic dysfunction and altered ejection fraction occurrence. However, further studies assessing the effect of vasodilators on heart-related outcome among SSc patients are needed to confirm those exploratory results.
Source: RMD Open
Authors: Alexis F Guédon, Fabrice Carrat, Luc Mouthon, David Launay, Benjamin Chaigne, Grégory Pugnet, Jean-Christophe Lega, Arnaud Hot, Vincent Cottin, Christian Agard, Yannick Allanore, Anne Laure Fauchais, Alain Lescoat, Robin Dhote, Thomas Papo, Emmanuel Chatelus, Bernard Bonnotte, Jean-Emmanuel Kahn, Elisabeth Diot, Achille Aouba, Nadine Magy-Bertrand, Viviane Queyrel, Alain Le Quellec, Pierre Kieffer, Zahir Amoura, Brigitte Granel, Jean Baptiste Gaultier, Marie-Hélène Balquet, Denis Wahl, Olivier Lidove, Olivier Espitia, Ariel Cohen, Olivier Fain, Eric Hachulla, Arsène Mekinian, Sébastien Rivière
Institutions: Sorbonne Université, Hôpital Saint-Antoine, Institut Pierre Louis d‘Épidémiologie et de Santé Publique, Hôpital Cochin, Inserm, Université de Lille, Centre Hospitalier Universitaire de Lille, Centre Hospitalier Universitaire de Toulouse, Hospices Civils de Lyon, Hôpital Louis Pradel, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire de Limoges, Centre Hospitalier Universitaire de Rennes, Hôpital Avicenne, Hôpital Bichat-Claude-Bernard, Hôpitaux Universitaires de Strasbourg, CHU Dijon Bourgogne, Hôpital Ambroise-Paré, Centre Hospitalier Universitaire de Tours, Centre Hospitalier Universitaire de Caen Normandie, Centre Hospitalier Universitaire de Besançon, Centre Hospitalier Universitaire de Nice, Centre Hospitalier Universitaire de Montpellier, Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Pitié-Salpêtrière Hospital, Centre d'Immunologie et des Maladies Infectieuses, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Universitaire de Saint-Étienne, Centre Hospitalier de Lens, Centre Hospitalier Régional et Universitaire de Nancy, Groupe Hospitalier Diaconesses Croix Saint-Simon
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,391
OpenAlex ID: W4405216826