Similar Symptoms Found in Scleroderma Patients in the U.S., Regardless of Their Immunosuppressant Use, Study Finds

About a third of people diagnosed with scleroderma in the U.S. were prescribed immunosuppressive therapies in the first year after their diagnosis, but their symptoms were found to be similar to those of other scleroderma patients — possibly indicating the low efficacy of these treatments, a study has found.

Titled “Characterizing Disease Manifestations and Treatment Patterns Among Adults with Systemic Sclerosis: A Retrospective Analysis of a US Healthcare Claims Population,” the study was published in Rheumatology and Therapy.

Although results of clinical trials have shown limited efficacy with safety risks, immunosupressive therapies (IMTs), such as methotrexate, cyclophosphamide, and mycophenolate mofetil, are recommended for people with scleroderma.

However, real-world information is lacking for the use of this type of therapy, which is designed to reduce the activity of the immune system, in scleroderma patients.

In the study, researchers at Genentech analyzed insurance claims in the U.S. by using the Truven Health MarketScan Research Databases, which included information from 6,852 people identified between 2006 and 2013. Of these, 2,404 (30.8%) received treatment with IMTs.

Results showed that the most commonly prescribed medications in the first year after diagnosis were antibiotics (61.7% of patients), opioids (50.6%), and glucocorticoids (46.5%). Among patients who received IMTs, the most frequently prescribed was hydroxychloroquine (43.8%), followed by methotrexate (21.1%), and mycophenolate mofetil (17.6%). A total of 460 switched to a second IMT.

The most common symptoms were musculoskeletal problems (16.1%) and fatigue (10.5%).

IMTs were most commonly prescribed for respiratory, cardiac, gastrointestinal, and skin symptoms. These complications were also the most common in the overall group, indicating that the decision to prescribe IMTs was not based on a pattern of clinical symptoms.

“[T]he characterization of disease manifestations was similar between patients receiving IMTs and the overall SSc [scleroderma] healthcare claims population, suggesting that patients who received IMTs did not have any particularly unique organ manifestations … or that IMTs are not considered beneficial for a particular organ manifestation,” the researchers wrote.

Their study suggests that the majority of people in the overall group had only mild disease without organ involvement needing treatment, or that existing treatment options have limited efficacy.

“The present study provides a snapshot of treatment patterns for SSc in the USA, but it is a rapidly changing landscape, and treatment patterns should continue to be investigated as new therapies are developed,” the team wrote.