By Dr Deepu
Researchers
found that “in patients with symptomatic systemic sclerosis (SSc)-related
interstitial lung disease (ILD), 1-year treatment with the immunosuppressant
cyclophosphamide (CYC) is associated with short-term improvements in forced
vital capacity (FVC)%-predicted and the modified Rodnan skin score (mRSS), but
not in the diffusing capacity of the lungs for carbon monoxide
(DLCO)%-predicted.”
Participants
enrolled in the CYC arms of SLS I (n = 79) and II (n = 69) were included in the
study. SLS I and II randomized participants to oral CYC for 1 year and followed
patients for an additional year off therapy (in SLS II, patients received
placebo in Year 2). Outcomes included the forced vital capacity
(FVC%)-predicted and DLCO%-predicted (measured every 3 months) and quantitative
radiographic extent of interstitial lung disease (measured at 1 and 2 yearsrs for
SLS I and SLS II, respectively). Joint models were created to evaluate the
treatment effect on the course of the FVC/DLCO over 2 years while controlling
for baseline disease severity.
Researchers
found that SLS I and II CYC participants had similar baseline characteristics.
After adjusting for baseline disease severity, there was no difference in the
course of the FVC%-predicted (p = 0.535) nor the DLCO%-predicted (p = 0.172)
between the SLS I and II CYC arms. In both groups, treatment with CYC led to a
significant improvement in the FVC%-predicted from 3 to 12 months, but no
significant improvement beyond this point. Treatment with CYC had no effect on
the DLCO for either group.
Finally they
could conclude that Treatment with 1 year of oral CYC led to similar
improvements in lung function in both SLS I and II, although the effects were
not sustained following cessation of CYC. These results suggest that increasing
the duration of ILD therapy may improve outcomes for patients with systemic
sclerosis–ILD.
The findings were published in the Journal of Rheumatology.
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