{"title":"Immunosuppressive Drugs in Early Systemic Sclerosis and Prevention of Damage Accrual.","authors":"Murray Baron, Mandana Nikpour, Dylan Hansen, Susanna Proudman, Wendy Stevens, Mianbo Wang","doi":"10.1002/acr.25467","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Organ damage in patients with systemic sclerosis (SSc) in individual organs such as the lungs may be prevented by receiving immunosuppressive drugs (ISs). A new measure of global organ damage, the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI), has allowed us to investigate whether receiving ISs may reduce global organ damage accrual in patients with early SSc.</p><p><strong>Methods: </strong>This was a retrospective study of patients with two or less years of disease duration in Canadian and Australian cohorts with SSc. Patients with either limited cutaneous SSc (lcSSc) or diffuse cutaneous SSc (dcSSc) were observed separately and divided into groups who were either ever or never exposed to ISs. The SCTC-DI was the outcome, and inverse probability of treatment weighting (IPTW) was used to balance the study groups and to fit a marginal structural generalized estimating equation model.</p><p><strong>Results: </strong>In the cohort with lcSSc, there were 210 patients, of whom 34% were exposed to ISs at some time. Exposure to ISs was associated with lower damage scores. In the cohort with dcSSc, there were 192 patients, of whom 76% were exposed to ISs at some time. Exposure to ISs was not associated with damage scores.</p><p><strong>Conclusion: </strong>In this retrospective observational cohort study, using IPTW to adjust for confounders, we found a protective effect of receiving ISs on damage accrual in patients with lcSSc. We were unable to determine such an effect in patients with dcSSc, but unknown confounders may have been present, and prospective studies of patients with dcSSc receiving ISs should include the SCTC-DI to determine the possible effect of ISs on damage accrual.</p>","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthritis Care & Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/acr.25467","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Organ damage in patients with systemic sclerosis (SSc) in individual organs such as the lungs may be prevented by receiving immunosuppressive drugs (ISs). A new measure of global organ damage, the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI), has allowed us to investigate whether receiving ISs may reduce global organ damage accrual in patients with early SSc.
Methods: This was a retrospective study of patients with two or less years of disease duration in Canadian and Australian cohorts with SSc. Patients with either limited cutaneous SSc (lcSSc) or diffuse cutaneous SSc (dcSSc) were observed separately and divided into groups who were either ever or never exposed to ISs. The SCTC-DI was the outcome, and inverse probability of treatment weighting (IPTW) was used to balance the study groups and to fit a marginal structural generalized estimating equation model.
Results: In the cohort with lcSSc, there were 210 patients, of whom 34% were exposed to ISs at some time. Exposure to ISs was associated with lower damage scores. In the cohort with dcSSc, there were 192 patients, of whom 76% were exposed to ISs at some time. Exposure to ISs was not associated with damage scores.
Conclusion: In this retrospective observational cohort study, using IPTW to adjust for confounders, we found a protective effect of receiving ISs on damage accrual in patients with lcSSc. We were unable to determine such an effect in patients with dcSSc, but unknown confounders may have been present, and prospective studies of patients with dcSSc receiving ISs should include the SCTC-DI to determine the possible effect of ISs on damage accrual.
目的:免疫抑制剂(IS)可预防系统性硬化症(SSc)中肺部等个别器官的损伤。硬皮病临床试验联盟损伤指数(SCTC-DI)是衡量全身器官损伤的一种新方法,它使我们能够研究免疫抑制剂是否能减少早期系统性硬化症的全身器官损伤:这是一项回顾性研究,研究对象是加拿大和澳大利亚SSc队列中病程小于2年的患者。分别观察了局限性皮肤型(lcSSc)或弥漫性皮肤型(dcSSc)SSc 患者,并将其分为曾经接触过 IS 组和从未接触过 IS 组。研究结果以SCTC-DI为指标,并采用逆概率治疗加权法(IPTW)来平衡各研究组,并拟合边际结构广义估计方程(GEE)模型:在lcSSc队列中,共有210名受试者,其中34%的受试者曾经接触过IS。暴露于 IS 与较低的损伤评分有关。在 dcSSc 队列中,有 192 名受试者,其中 76% 的人曾在一段时间内接触过 IS。暴露于 IS 与损伤评分无关:在这项回顾性观察队列研究中,我们使用 IPTW 对混杂因素进行了调整,发现在 lcSSc 中使用 IS 对损伤累积有保护作用。我们无法确定在 dcSSc 中是否存在这种效应,但可能存在未知的混杂因素,因此对 dcSSc 中 IS 的前瞻性研究应包括 SCTC-DI,以确定 IS 对损伤累积的可能效应。
期刊介绍:
Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.