Study maps shift in prescribing patterns as guidelines evolve
Blood pressure meds prescribed more, corticosteroids less
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Treatment guidelines for scleroderma (SSc) have evolved since the turn of the century with advances in scientific understanding and the advent of new therapies.
In line with these evolving guidelines, patterns of therapies prescribed to people with SSc have shifted markedly since 2000, according to a new analysis from Germany.
The study found, however, that prescribing patterns vary between academic and non-academic medical centers. The researchers said this highlights a need for continued standardization to ensure that everyone with SSc receives the best possible care in line with the most up-to-date guidelines.
The study, “Real-world treatment patterns and determinants of therapy in systemic sclerosis: findings from the German Network for SSc cohort,” was published in Arthritis Research & Therapy.
SSc is an inflammatory disorder that can cause scarring in various tissues throughout the body. A range of therapies may be used to manage SSc and its various manifestations. For their study, the scientists used a national study in Germany to track how medications prescribed for SSc shifted from 2000 to 2025.
Blood pressure meds up, corticosteroids down
The researchers found many changes in prescribing patterns that reflect newer treatment guidelines based on an evolving understanding of SSc and how best to manage it. For example, there’s been a marked increase in the use of medications to lower blood pressure, especially for a particular class of meds called endothelin receptor antagonists (ERAs). In 2005, 3% of SSc patients were on ERAs; by 2024, more than a quarter (28.4%) were.
The increased use of blood pressure medicines likely reflects a growing understanding that these medications can help ease the SSc symptom known as Raynaud’s phenomenon, as well as better treatment of pulmonary hypertension (elevated pressure in the lungs’ blood vessels, a common complication in SSc), the team suggested.
“This study shows that the treatment of SSc has changed markedly over the past 25 years, with prescribing patterns aligning with recent evidence from clinical trials and updated guideline recommendations,” the researchers wrote.
While blood pressure meds are now more common, the use of corticosteroids has decreased in recent decades. In 2000, half of SSc patients were on corticosteroids, but this rate dropped to fewer than one in five by 2025. Again, this change reflects updated guidelines: Corticosteroids are anti-inflammatory medications that are commonly used to help manage a range of inflammatory disorders, but in recent years, it’s been shown that they offer limited benefit in SSc. And use of corticosteroids, especially at high doses, can increase the risk of kidney damage in SSc, so there’s been an increasing push to limit their use in this population.
Other changes reflect the introduction of new therapies, including increased use of nintedanib (sold as Ofev and available as generics), an oral therapy approved to treat interstitial lung diseases (ILDs), a broad category of disorders marked by lung scarring, among other indications. There have similarly been increases in the use of Actemra (tocilizumab), another approved treatment for ILDs in people with SSc.
Although the changes broadly reflect updates in treatment guidelines, the researchers noted that these updates were not being implemented uniformly. For example, even though corticosteroids were less commonly used overall, they were more likely to be used in non-academic centers. There were also differences in prescribing patterns across specialty center types: For example, rheumatology centers were more likely to prescribe immunomodulating therapies than dermatological centers.
“The reduced use of [corticosteroids], alongside greater adoption of vascular therapies, nintedanib, and biologic immunomodulators, suggests that recent evidence is being incorporated into routine clinical practice,” the researchers wrote. “At the same time, substantial differences in treatment approaches between specialties and between expert and non-expert centers remain evident. These findings highlight the need for dissemination of guideline-based care and intensified multidisciplinary collaboration to ensure that patients with SSc receive comparable and evidence-based management across care settings.”
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