More SSc-ILD patients receive early treatment, new study finds
ILD progression rates decline over time in EUSTAR registry
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The use of immunosuppressive and combination treatments for interstitial lung disease associated with systemic sclerosis (SSc-ILD) has increased significantly over the past two decades, with more than half of patients now starting treatment at their first evaluation, according to a new study.
Over the same period, rates of ILD progression declined. However, the prognosis for people with SSc-ILD “remains suboptimal,” the researchers wrote, highlighting the need for more effective treatments.
The study, “Impact of evolving treatment patterns on interstitial lung disease progression in systemic sclerosis using the EUSTAR database,” was published in Arthritis & Rheumatology.
Understanding SSc-ILD and evolving treatment options
SSc is a type of scleroderma, an autoimmune disease that can cause skin thickening and damage to internal organs. When it affects the lungs, it can lead to ILD, in which lung tissue becomes inflamed and scarred, making breathing more difficult.
Over the past two decades, more treatments have become available for SSc-ILD, including immunosuppressants, which reduce immune system activity, and anti-fibrotic medications, which aim to slow scarring. However, how these treatments are used in everyday practice remains unclear.
In this study, an international team of researchers in Europe examined how treatment patterns have changed over time and how lung disease progression rates varied across those periods. The researchers used data from the EUSTAR database, a large European registry of people with systemic sclerosis.
The study included a total of 1,409 SSc-ILD patients, who were divided into four treatment periods: 2006 or earlier, 2007–2011, 2012–2016, and 2017 or later. The researchers looked at whether patients started immunosuppressive treatments at their first evaluation, switched treatments, discontinued therapy, or used combination treatments (two or more medications together).
Immunosuppressive and combination therapy use rises over time
Results showed that the use of immunosuppressants at the first evaluation increased substantially over time, rising from 13.6% in 2006 or earlier to 57.4% in 2017 or later. Mycophenolate mofetil, an immunosuppressive medication, became the most commonly used therapy, with its use increasing from 3% to 24% during the study period.
The use of combination treatments also increased, from 17.9% to 26.9%. During the same periods, the rate of lung disease progression decreased significantly from 21.3% in 2007–2011 to 12.1% in 2017 or later.
Among patients treated in 2017 or later, certain factors were associated with starting treatment at the first evaluation. Longer disease duration was linked to a lower likelihood of initiating therapy, while people with muscle inflammation were nearly 10 times more likely to begin treatment at their first visit.
Patients with higher modified Rodnan skin scores (mRSS), a measure of skin thickness, and those with arthritis were more likely to switch treatments. No factors were significantly associated with stopping treatment.
Treatment practices evolve, but unmet needs remain
Overall, treatment practices have changed significantly over time. However, because some patients continue to experience lung disease progression, there remains a need for more effective treatment options.
“This study reveals a clear change in the management of SSc-ILD, characterized by treatment initiation at their first evaluation nowadays in most SSc-ILD patients, the widespread use of ILD specific treatment options, and the increasing use of combination and switch strategies,” the researchers wrote.
“As treatment paradigms continue to evolve, future research must integrate these real-world patterns into clinical trial design and explore novel therapeutic targets to further improve patient outcomes,” the researchers concluded.
