Mycophenolate versus cyclophosphamide for progressive interstitial lung disease associated with systemic sclerosis: a...

Area of Science:

• Pulmonary Medicine
• Rheumatology
• Pharmacology

Background:

• Cyclophosphamide is the standard treatment for systemic sclerosis-associated interstitial lung disease (SSc-ILD), but its efficacy is limited.
• Mycophenolate is increasingly used as an alternative, despite a lack of controlled evidence.

Purpose of the Study:

• To compare the long-term efficacy of mycophenolate and cyclophosphamide in treating SSc-ILD.
• To evaluate the impact of these treatments on pulmonary function and high-resolution computed tomography (HRCT) findings.

Main Methods:

• 1:1 matched cohort study comparing mycophenolate and cyclophosphamide treated patients with SSc-ILD for over one year.
• Assessment of changes in forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO), and HRCT scans.
• Inclusion of an unmatched control group that did not receive either treatment.

Main Results:

• Neither mycophenolate nor cyclophosphamide significantly altered FVC, TLC, or DLCO after one or two years of treatment.
• Pulmonary function tests remained stable in the control group.
• Despite cyclophosphamide-treated patients having more advanced ILD at baseline, HRCT findings deteriorated in the mycophenolate group after two years, but not in the cyclophosphamide group.

Conclusions:

• The study, while limited by patient selection, does not support replacing cyclophosphamide with mycophenolate for SSc-ILD.
• Cyclophosphamide may remain the preferred treatment option for SSc-ILD.