Immunosuppression does not prevent severe gastrointestinal tract involvement in systemic sclerosis

Area of Science:

• Rheumatology
• Gastroenterology
• Immunology

Background:

• Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis and vascular abnormalities.
• Gastrointestinal (GIT) involvement is a common and potentially severe complication of SSc.
• The role of early immunosuppressive therapy in modulating SSc-related GIT disease risk is not well-established.

Purpose of the Study:

• To investigate whether early exposure to immunosuppressive agents influences the risk of developing severe gastrointestinal (GIT) disease in patients with systemic sclerosis (SSc).

Main Methods:

• A cohort of 762 early SSc patients (disease duration <3 years) without baseline severe GIT disease was analyzed.
• Exposure to immunosuppressants (methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine) was assessed.
• Severe GIT disease was defined by malabsorption, hyperalimentation, pseudo-obstruction, or significant weight loss.
• Inverse probability of treatment weights (IPTW) and a marginal structural Cox model were used to estimate the hazard ratio.

Main Results:

• During a mean follow-up of 4.0 years, severe GIT involvement occurred in 11.6% of exposed and 6.8% of unexposed subjects.
• The IPTW-adjusted analysis revealed no significant association between immunosuppression exposure and severe GIT disease (weighted hazard ratio 0.91).

Conclusions:

• Early immunosuppressive therapy does not appear to modify the risk of developing severe gastrointestinal involvement in patients with systemic sclerosis.
• These findings suggest that immunosuppressants may not be protective against severe GIT complications in early SSc.