Gastroprotective agents strike out on ILD prevention in systemic sclerosis

Use of gastroprotective and promotility agents does not appear to reduce the incidence of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc), a study reports.

The study used data from the Canadian Scleroderma Research Group registry and included 798 SSc patients. Treatment with gastroprotective and promotility agents was assessed as the primary and secondary exposure, respectively.

At baseline, median SSc duration of the cohort was 7.6 (interquartile range [IQR], 3.9–15.6) years. A total of 158 incident ILD cases occurred during a median follow-up of 4.4 (IQR, 2.6–7.2) years. This corresponded to a crude incidence of 4.4 (95 percent confidence interval [CI], 3.8–5.1) events per 100 person-years.

A total of 2,085 (73.4 percent) person-visits were exposed to gastroprotective agents, 579 (20.4 percent) were exposed to promotility agents, and 554 (19.5 percent) were exposed to both agents.

Multivariate marginal structural Cox model, which incorporated inverse probability of treatment weights, failed to demonstrate a beneficial effect for gastroprotective agents on incident ILD (hazard ratio [HR], 0.86, 95 percent CI, 0.52–1.41).

Likewise, treatment with promotility agents had a null effect on the outcome (HR, 0.79, 95 percent CI, 0.35-1.77).

A common complication of SSc, ILD contributes to significant morbidity and is one of the leading causes of premature mortality for patients. SSc-ILD is currently treated using immunosuppressive drugs, which, however, are generally ineffective at producing significant improvements in lung function. [Rheumatology 2020;59:1108-1117]