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
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