Baron Murray, Nikpour Mandana, Hansen Dylan, Proudman Susanna, Stevens Wendy, Wang Mianbo
Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
The University of Sydney and Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Arthritis Care Res (Hoboken). 2025 May;77(5):640-648. doi: 10.1002/acr.25467. Epub 2025 Feb 2.
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.
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.
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.
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.
系统性硬化症（SSc）患者的肺部等单个器官的损伤可通过接受免疫抑制药物（ISs）来预防。一种新的全球器官损伤衡量指标，即硬皮病临床试验联盟损伤指数（SCTC-DI），使我们能够研究接受ISs是否可减少早期SSc患者的全球器官损伤累积。
这是一项对加拿大和澳大利亚队列中病程在两年及以内的SSc患者的回顾性研究。局限性皮肤型SSc（lcSSc）或弥漫性皮肤型SSc（dcSSc）患者分别进行观察，并分为曾接受或从未接受过ISs的组。以SCTC-DI为观察指标，采用治疗权重逆概率（IPTW）来平衡研究组并拟合边际结构广义估计方程模型。
在lcSSc队列中，有210名患者，其中34%在某个时间接受过ISs。接受ISs与较低的损伤评分相关。在dcSSc队列中，有192名患者，其中76%在某个时间接受过ISs。接受ISs与损伤评分无关。
在这项回顾性观察队列研究中，使用IPTW调整混杂因素后，我们发现接受ISs对lcSSc患者的损伤累积有保护作用。我们无法确定在dcSSc患者中有这样的作用，但可能存在未知的混杂因素，对接受ISs的dcSSc患者的前瞻性研究应纳入SCTC-DI以确定ISs对损伤累积的可能影响。
