Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Internal Medicine, National Research Center, Cairo, Egypt.
RMD Open. 2024 Jul 24;10(3):e004333. doi: 10.1136/rmdopen-2024-004333.
While important progress was made regarding the treatment of systemic sclerosis (SSc), there is still no evidence-based disease-modifying treatment available for SSc-related gastrointestinal (GI) manifestations. We aimed to identify an association between immunosuppressive therapy and the the severity of GI symptoms, measured by the University of California at Los Angeles/Scleroderma Clinical Trial Consortium Gastro-Intestinal Tract instrument 2.0 (GIT).
We selected patients with SSc who had at least two visits (further referred to as 'baseline' and 'follow-up') with completed GITs, within an interval of 12±3 months. The study outcome was the GIT score at follow-up. We used multivariable linear regression with the following covariates: immunosuppressive therapy during observation, immunosuppressive therapy before baseline, baseline GIT and several baseline parameters selected by clinical judgement as potentially influencing GI symptoms.
We included 209 SSc patients (82.3% female, median age 59.0 years, median disease duration 6.0 years, 40 (19.1%) diffuse cutaneous SSc, median baseline GIT 0.19). Of these, 71 were exposed to immunosuppressive therapy during the observation period, and, compared with unexposed patients, had overall more severe SSc and a higher prevalence of treatment with proton pump inhibitors. In multivariable linear regression, immunosuppressive therapy during the period of observation and lower baseline GIT scores were significantly associated with lower (better) GIT scores at follow-up.
Immunosuppressive treatment was associated with lower GIT scores in our cohort, which suggests the potential effects of immunosuppressants on GI manifestations in patients with SSc, requiring confirmation in prospective randomised clinical trials.
尽管在系统性硬化症（SSc）的治疗方面取得了重要进展，但目前仍缺乏针对 SSc 相关胃肠道（GI）表现的基于证据的疾病改善治疗方法。我们旨在确定免疫抑制治疗与加利福尼亚大学洛杉矶分校/硬皮病临床试验联盟胃肠道 2.0 仪器（GIT）测量的 GI 症状严重程度之间的关联。
我们选择了至少有两次就诊（进一步称为“基线”和“随访”）且 GIT 完整的 SSc 患者，两次就诊的间隔为 12±3 个月。研究结果是随访时的 GIT 评分。我们使用多变量线性回归，纳入以下协变量：观察期间的免疫抑制治疗、基线前的免疫抑制治疗、基线 GIT 以及根据临床判断选择的几个可能影响 GI 症状的基线参数。
我们纳入了 209 名 SSc 患者（82.3%为女性，中位年龄 59.0 岁，中位疾病病程 6.0 年，40 名（19.1%）为弥漫性皮肤 SSc，中位基线 GIT 为 0.19）。其中，71 名患者在观察期间接受了免疫抑制治疗，与未接受治疗的患者相比，他们的 SSc 总体更为严重，质子泵抑制剂治疗的比例更高。多变量线性回归分析显示，观察期间的免疫抑制治疗和较低的基线 GIT 评分与随访时较低（更好）的 GIT 评分显著相关。
在我们的队列中，免疫抑制治疗与较低的 GIT 评分相关，这表明免疫抑制剂对 SSc 患者的 GI 表现可能具有潜在影响，需要在前瞻性随机临床试验中得到证实。
