Fairley Jessica L, Hansen Dylan, Proudman Susanna, Sahhar Joanne, Ngian Gene-Siew, Apostolopoulos Diane, Walker Jennifer, Host Lauren V, Stevens Wendy, Ross Laura, Nikpour Mandana
The University of Melbourne, Melbourne, VIC, Australia.
Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
J Scleroderma Relat Disord. 2025 May 22:23971983251342690. doi: 10.1177/23971983251342690.
To assess the frequency and determinants of immunosuppressant medication use in systemic sclerosis and changes in prescribing patterns over time.
The Australian Scleroderma Cohort Study participants meeting the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for systemic sclerosis with recorded treatment data were included. The Chi-square, two-sample -tests or Wilcoxon rank-sum tests were used for between-group comparison as appropriate. Multivariable logistic regression models were used to establish the determinants of the use of immunosuppressants.
Of 2019 participants, 60% received immunosuppressants, including 81% of those with diffuse systemic sclerosis and 52% of those with limited systemic sclerosis (p < 0.001). Forty-six percent of patients received prednisolone and 40% disease-modifying anti-rheumatic drugs. Immunosuppressant use was more common in those with severe or inflammatory systemic sclerosis features, including interstitial lung disease, synovitis or myositis. Comparing prescribing patterns early in incident systemic sclerosis from 2007-2014 to 2015-2024, disease-modifying anti-rheumatic drug use increased (35% vs 56%, p < 0.001), while prednisolone use decreased (24% vs 17%, p = 0.046). Immunosuppressants were commenced earlier in incident systemic sclerosis in 2015-2024 versus 2007-2014 (1.8 (interquartile range = 1.0-3.2) vs 2.4 (interquartile range = 1.2-4.0) years, p = 0.011). In multivariable modelling, prednisolone use was associated with diffuse systemic sclerosis (odds ratio = 1.8, 95% confidence interval = 1.4-2.2, p < 0.001), interstitial lung disease (odds ratio = 2.1, 95% confidence interval = 1.7-2.5, p < 0.001), myositis (odds ratio = 2.7, 95% confidence interval = 1.8-4.0, p < 0.001), synovitis (odds ratio = 2.2, 95% confidence interval = 1.8-2.6, p < 0.001) and systemic sclerosis heart involvement (odds ratio = 1.4, 95% confidence interval = 1.0-2.0, p = 0.044). Disease-modifying anti-rheumatic drug exposure was associated with diffuse systemic sclerosis (odds ratio = 2.7, 95% confidence interval = 2.1-3.4, p < 0.001), interstitial lung disease (odds ratio = 2.2, 95% confidence interval = 1.7-2.7, p < 0.001), myositis (odds ratio = 3.6, 95% confidence interval = 2.4-5.5, p < 0.001) and synovitis (odds ratio = 4.2, 95% confidence interval = 3.5-5.2, p < 0.001) and inversely associated with age (odds ratio = 0.7, 95% confidence interval = 0.5-0.8, p < 0.01) and pulmonary arterial hypertension (odds ratio = 0.5, 95% confidence interval = 0.4-0.7, p < 0.001). In subgroups with diffuse systemic sclerosis and limited systemic sclerosis and different autoantibody profiles, findings were generally similar, with interstitial lung disease, synovitis and myositis tending to be associated with prednisolone and/or disease-modifying anti-rheumatic drug use, as was systemic sclerosis heart involvement in diffuse systemic sclerosis (p = 0.038).
Immunosuppressant use is common in systemic sclerosis, with broadly similar determinants of usage among subtypes and autoantibody status. These real-world data suggest that disease-modifying anti-rheumatic drug use has increased, with earlier implementation of treatment, and a reduction in use of glucocorticoids.
评估系统性硬化症中免疫抑制剂的使用频率和决定因素，以及随时间推移处方模式的变化。
纳入澳大利亚硬皮病队列研究中符合美国风湿病学会/欧洲风湿病协会联盟系统性硬化症标准且有治疗数据记录的参与者。根据情况，使用卡方检验、双样本t检验或Wilcoxon秩和检验进行组间比较。使用多变量逻辑回归模型确定免疫抑制剂使用的决定因素。
在2019名参与者中，60%接受了免疫抑制剂治疗，其中弥漫性系统性硬化症患者中有81%，局限性系统性硬化症患者中有52%（p<0.001）。46%的患者接受了泼尼松龙治疗，40%的患者接受了改善病情的抗风湿药物治疗。免疫抑制剂在具有严重或炎症性系统性硬化症特征的患者中使用更为常见，包括间质性肺病、滑膜炎或肌炎。将2007 - 2014年与2015 - 2024年系统性硬化症发病早期的处方模式进行比较，改善病情的抗风湿药物使用增加（35%对56%，p<0.001），而泼尼松龙使用减少（24%对17%，p = 0.046）。2015 - 2024年系统性硬化症发病时开始使用免疫抑制剂的时间比2007 - 2014年更早（1.8（四分位间距 = 1.0 - 3.2）年对vs 2.4（四分位间距 = 1.2 - 4.0）年，p = 0.011）。在多变量模型中，使用泼尼松龙与弥漫性系统性硬化症相关（比值比 = 1.8，95%置信区间 = 1.4 - 2.2，p<0.001）、间质性肺病（比值比 = 2.1，95%置信区间 = 1.7 - 2.5，p<0.001）、肌炎（比值比 = 2.7，95%置信区间 = 1.8 - 4.0，p<0.001）、滑膜炎（比值比 = 2.2，95%置信区间 = 1.8 - 2.6，p<0.001）和系统性硬化症心脏受累（比值比 = 1.4，95%置信区间 = 1.0 - 2.0，p = 0.044）相关。使用改善病情的抗风湿药物与弥漫性系统性硬化症相关（比值比 = 2.7，95%置信区间 = 2.1 - 3.4，p<0.001）、间质性肺病（比值比 = 2.2，95%置信区间 = 1.7 - 2.7，p<0.001）、肌炎（比值比 = 3.6，95%置信区间 = 2.4 - 5.5，p<0.001）和滑膜炎（比值比 =
