Goldman Nina R, Nihtyanova Svetlana I, Beesley Claire F, Wells Athol U, Denton Christopher P, Renzoni Elisabetta A, Mageed Rizgar, Ong Voon H
Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom.
GSK, London, UK.
Rheumatology (Oxford). 2025 Jan 3. doi: 10.1093/rheumatology/keaf006.
Systemic sclerosis (SSc)-interstitial lung disease (ILD) is one of the leading causes of mortality in SSc. Data from randomised controlled trials (RCTs) supports rituximab and tocilizumab monotherapy but there is limited data regarding their use for those who fail standard immunomodulatory therapies.
SSc patients treated with rituximab or tocilizumab were retrospectively identified in a single centre cohort. Linear mixed effect models were used to analyse before and after treatment lung function trajectory and identify patient characteristics associated with treatment response.
127 patients were included for analysis. 51 of 94 (51.4%) and 13 of 33 (39.4%) of the rituximab and tocilizumab cohorts respectively were receiving concurrent mycophenolate mofetil. Pre-treatment decline in absolute change %FVC/year and %DLCO/year respectively, was similar in both cohorts (-3.2% and -4.0% rituximab and -3.2% and -3.6% tocilizumab). Both treatments resulted in lung function stabilisation (%FVC/year and %DLCO/year: 1.2% and +0.2% rituximab cohort, 1.0% and 1.0% tocilizumab cohort). Anti-topoisomerase antibody (ATA) positive patients had a significant response on %FVC/year to tocilizumab compared with ATA negative patients. Gender had a significant impact on %FVC/year response to rituximab, with males responding to a greater degree than females. Age, ILD extent and skin subset had no impact on treatment response.
Combination rituximab or tocilizumab with background immunosuppressive therapy is associated with stabilisation in lung function trajectory among those who remain refractory to standard immunosuppressives. Specific patient characteristics have an impact on lung function response. Improved FVC response among ATA patients receiving tocilizumab validate data from RCTs.
系统性硬化症（SSc）相关间质性肺疾病（ILD）是SSc患者死亡的主要原因之一。随机对照试验（RCT）数据支持利妥昔单抗和托珠单抗单药治疗，但对于那些标准免疫调节治疗无效的患者，关于这两种药物使用的数据有限。
在一个单中心队列中对接受利妥昔单抗或托珠单抗治疗的SSc患者进行回顾性识别。采用线性混合效应模型分析治疗前后的肺功能轨迹，并确定与治疗反应相关的患者特征。
纳入127例患者进行分析。利妥昔单抗组94例中有51例（51.4%）、托珠单抗组33例中有13例（39.4%）同时接受霉酚酸酯治疗。两组治疗前每年绝对变化的%FVC和%DLCO下降情况相似（利妥昔单抗组分别为-3.2%和-4.0%，托珠单抗组分别为-3.2%和-3.6%）。两种治疗均导致肺功能稳定（%FVC/年和%DLCO/年：利妥昔单抗组为1.2%和+0.2%，托珠单抗组为1.0%和1.0%）。抗拓扑异构酶抗体（ATA）阳性患者与ATA阴性患者相比，在每年%FVC方面对托珠单抗有显著反应。性别对利妥昔单抗治疗每年%FVC反应有显著影响，男性反应程度大于女性。年龄、ILD范围和皮肤亚型对治疗反应无影响。
对于对标准免疫抑制剂仍难治的患者，利妥昔单抗或托珠单抗联合背景免疫抑制治疗与肺功能轨迹稳定相关。特定患者特征对肺功能反应有影响。接受托珠单抗的ATA患者中FVC反应改善验证了RCT的数据。
