The following is a summary of “Preventive effects of early immunosuppressive treatment on the development of interstitial lung disease in systemic sclerosis,” published in the July 2024 issue of Rheumatology by Velauthapillai et al.

Researchers conducted a retrospective study exploring how the timing of immunosuppressive treatment affects the progression of interstitial lung disease (ILD) and pulmonary function in systemic sclerosis (SSc).

They created a cohort from the EUSTAR database and Nijmegen Systemic Sclerosis cohort, including adult patients who began their first immunosuppressive treatment (i.e., mycophenolate mofetil, methotrexate, cyclophosphamide, tocilizumab, or rituximab) post-SSc diagnosis and had no ILD signs on high-resolution CT. The ILD-free survival and forced vital capacity (FVC) % predicted for up to 5 years were assessed, comparing early starters (disease duration ≤3 years) vs. late starters with immunosuppression.

The result showed 1,052 patients in which the early treatment group (n = 547, 52%) had a higher prevalence of male patients, diffuse cutaneous subtype (53.1% vs. 36.5%), and anti-topoisomerase-I antibody (ATA) positivity (51.1% vs. 42.7%). Methotrexate was the most commonly used treatment (60.1%), while biological therapies were administered to only a small percentage of patients (1.7%). The incidence of ILD was 46.6% after an average of 3.6 (SD 1.4) years. After adjusting for confounders, the HR for ILD in the early treatment group was 1.13 (95% CI: 0.93–1.38). The trajectories of ppFVC were similar between the early and late treatment groups.

Investigators concluded that early immunosuppressive therapy did not prevent ILD compared to late initiation, with caution advised due to cohort characteristics and usage of limited biological treatment.

Source: academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keae375/7717972