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09-10-2019 | Systemic sclerosis | News

Immunosuppressive therapy reduces progression of mild ILD in patients with SSc


medwireNews: A retrospective study shows that treating mild interstitial lung disease (ILD) with immunosuppressive drugs preserves lung function in patients with systemic sclerosis (SSc).

“In this real-world setting, [cyclophosphamide/mycophenolate] exposure at baseline was associated with higher FVC [forced vital capacity] values and a lower risk of progression among subjects with mild ILD,” say Sabrina Hoa (Jewish General Hospital, Montreal, Québec, Canada) and study co-authors in Rheumatology.

Among 116 patients with SSC and mild ILD, defined as an 85% or above predicted FVC, the 13 who started treatment with cyclophosphamide or mycophenolate had a predicted FVC after a year that was 8.49% higher than that of 103 patients who did not take immunosuppressive drugs. The patients were identified from the Canadian Scleroderma Research Group Registry.

During 3.6 years of follow-up, none of the patients with mild ILD who received immunosuppressive therapy had clinically meaningful progression, whereas among those not exposed, 18.5% had progressed at 1 year and 24.5% at 2 years.

Hoa and colleagues highlight that the “results support our hypothesis that a window of opportunity exists for the treatment of SSc-ILD.”

They note that immunosuppressive therapy did not have the same benefit for the 130 patients with SSc and moderate ILD, defined as a baseline predicted FVC of 45–85%. Exposure to immunosuppressive drugs in this group was associated with a nonsignificant 2.04% lower predicted FVC a year later, compared with no exposure.

Hoa et al validated this finding by reclassifying the severity of ILD in 194 eligible patients using different thresholds of 100%, 90%, 80%, and 70% predicted FVC. This showed that while there was no difference in average FVC at 1 year between patients exposed and not exposed to immunosuppressive drugs for the whole cohort, the difference in FVC between the groups increased by 1.9% with each 10-unit increase in baseline percent predicted FVC.

The researchers stress that “although the FVC improved in exposed mild SSc-ILD subjects, whether this translates into meaningful outcomes for patients—such as improved exercise tolerance, dyspnoea or health related quality of life—remains to be defined.”

By Hannah Kitt

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Rheumatology 2019; doi:10.1093/rheumatology/kez407