Background The treatment landscape for systemic sclerosis‐associated interstitial lung disease (SSc‐ILD) has evolved with increasing immunosuppressive (IST) and anti‐fibrotic therapies available. However, their real‐world use remains unclear. Objectives To analyze treatment trends and the effect of IST and anti‐fibrotic therapies on ILD progression using the EUSTAR database. Methods We included SSc‐ILD patients meeting the 2013 ACR/EULAR criteria with high‐resolution CT‐confirmed ILD, pulmonary function, and therapy data, grouped into four time periods (≤2006, 2007–2011, 2012–2016, ≥2017). We analyzed IST initiation, switching, discontinuation, and combination therapy. ILD progression was defined as a decline in %FVC ≥5% or %DLCO ≥10% over 12 ± 3 months. Results Among 1,409 patients, IST use at first evaluation increased significantly from 13.6% (≤2006) to 57.4% (≥2017, p<0.001). Mycophenolate mofetil emerged as the most prescribed IST (7% to 57%, p<0.001). Combination therapy rose from 17.9% to 26.9% (p<0.001), while ILD progression rates declined from 21.3% (2007–2011) to 12.1% (≥2017, p<0.001). In the ≥2017 cohort, logistic regression showed shorter disease duration (Odds ratio (OR) 0.991, 95%CI 0.987–0.996, p <0.001) and myositis (OR 9.9, 95% CI 1.94‐51.76, p=0.006) were associated with therapy initiation, while switching was higher in patients with a higher mRSS (OR 1.03, 95%CI 1.00–1.06, p=0.035) and in patients with arthritis (OR 3.03, 95% CI 1.55–5.94, p=0.001). Lastly, combination therapy was associated with younger age, higher dyspnea class and arthritis. Conclusions Our findings reveal a significant evolution in clinical practice. However, continued disease progression emphasizes the need for more effective therapeutic approaches. image
Campochiaro et al. (Thu,) studied this question.