Systemic sclerosis associated interstitial lung disease - individualized immunosuppressive therapy and course of lung function: results of the EUSTAR group.

Adler, Sabine; Huscher, Dörte; Siegert, Elise; Allanore, Yannick; Czirják, László; DelGaldo, Francesco; Denton, Christopher P; Distler, Oliver; Frerix, Marc; Matucci-Cerinic, Marco; Mueller-Ladner, Ulf; Tarner, Ingo-Helmut; Valentini, Gabriele; Walker, Ulrich A; Villiger, Peter; Riemekasten, Gabriela (2018). Systemic sclerosis associated interstitial lung disease - individualized immunosuppressive therapy and course of lung function: results of the EUSTAR group. Arthritis research & therapy, 20(1), p. 17. BioMed Central 10.1186/s13075-018-1517-z

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BACKGROUND Interstitial lung disease in systemic sclerosis (SSc-ILD) is a major cause of SSc-related death. Imunosuppressive treatment (IS) is used in patients with SSc for various organ manifestations mainly to ameliorate progression of SSc-ILD. Data on everyday IS prescription patterns and clinical courses of lung function during and after therapy are scarce. METHODS We analysed patients fulfilling American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) 2013 criteria for SSc-ILD and at least one report of IS. Types of IS, pulmonary function tests (PFT) and PFT courses during IS treatment were evaluated. RESULTS EUSTAR contains 3778/11,496 patients with SSc-ILD (33%), with IS in 2681/3,778 (71%). Glucocorticoid (GC) monotherapy was prescribed in 30.6% patients with GC combinations plus cyclophosphamide (CYC) (11.9%), azathioprine (AZA) (9.2%), methotrexate (MTX) (8.7%), or mycophenolate mofetil (MMF) (7.3%). Intensive IS (MMF + GC, CYC or CYC + GC) was started in patients with the worst PFTs and ground glass opacifications on imaging. Patients without IS showed slightly less worsening in forced vital capacity (FVC) when starting with FVC 50-75% or >75%. GC showed negative trends when starting with FVC <50%. Regarding diffusing capacity for carbon monoxide (DLCO), negative DLCO trends were found in patients with MMF. CONCLUSIONS IS is broadly prescribed in SSc-ILD. Clusters of clinical and functional characteristics guide individualised treatment. Data favour distinguished decision-making, pointing to either watchful waiting and close monitoring in the early stages or start of immunosuppressive treatment in moderately impaired lung function. Advantages of specific IS are difficult to depict due to confounding by indication. Data do not support liberal use of GC in SSc-ILD.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology

UniBE Contributor:

Villiger, Peter

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1478-6354

Publisher:

BioMed Central

Language:

English

Submitter:

Burkhard Möller

Date Deposited:

17 Jul 2019 14:48

Last Modified:

22 Oct 2019 22:32

Publisher DOI:

10.1186/s13075-018-1517-z

PubMed ID:

29382380

Uncontrolled Keywords:

Follow up Immunosuppressants Interstitial lung disease Lung function Systemic sclerosis

BORIS DOI:

10.7892/boris.125133

URI:

https://boris.unibe.ch/id/eprint/125133

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