Impact of Evolving Treatment Patterns on Interstitial Lung Disease Progression in Systemic Sclerosis Using the...

Area of Science:

• Rheumatology
• Pulmonology
• Clinical Pharmacology

Background:

• Systemic sclerosis-associated interstitial lung disease (SSc-ILD) treatment has evolved with new immunosuppressive (IST) and anti-fibrotic therapies.
• Real-world utilization patterns of these therapies in SSc-ILD remain incompletely understood.

Purpose of the Study:

• To analyze temporal trends in SSc-ILD treatment strategies.
• To evaluate the impact of IST and anti-fibrotic therapies on ILD progression using the EUSTAR database.

Main Methods:

• Retrospective analysis of SSc-ILD patients from the EUSTAR database (n=1,409) meeting 2013 ACR/EULAR criteria.
• Patients were grouped into four time periods (≤2006, 2007-2011, 2012-2016, ≥2017) to assess IST initiation, switching, discontinuation, and combination therapy.
• ILD progression defined as ≥5% decline in %FVC or ≥10% decline in %DLCO over 12 months.

Main Results:

• IST use significantly increased from 13.6% to 57.4% (p<0.001), with mycophenolate mofetil becoming the most common IST.
• Combination therapy use rose from 17.9% to 26.9% (p<0.001), while ILD progression rates decreased from 21.3% to 12.1% (p<0.001).
• Factors associated with therapy initiation included shorter disease duration and myositis; switching was linked to higher mRSS and arthritis.

Conclusions:

• Clinical practice for SSc-ILD has significantly evolved, marked by increased IST utilization and combination therapy.
• Despite treatment advancements, a notable proportion of patients continue to experience disease progression, underscoring the need for more effective therapeutic strategies.