Abstract Introduction Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a common and often devastating manifestation of SSc, accounting for approximately one-third of SSc-related mortality. In 2019, clinical trial data demonstrated that the antifibrotic medication nintedanib could slow rate of lung function decline in SSc-ILD. As such, we aimed to assess prescribing patterns of nintedanib among patients with SSc-ILD in a large US cohort. Methods We performed a retrospective cohort study using TriNetx, a de-identified database of electronic health records and claims-based data from over 130 million patients at 104 health care organizations. We identified adults (⩾ 18 years) with a new diagnosis of SSc-ILD following as outpatients in the dataset with the following criteria 1) at least two ambulatory visits for scleroderma (ICD-10 M34.x) from 2016-2023, 2) at least one ambulatory visit for a non-scleroderma diagnosis before first scleroderma encounter, and 3) at least one ambulatory visit for a secondary ILD diagnosis code on the same day or after the first scleroderma visit. The ICD-10 code definitions for SSc and ILD were adapted from previously validated algorithms for identifying SSc-ILD in administrative databases. Patients were excluded if they had diagnosis codes for other rheumatologic diseases or did not contribute medication data. We calculated overall rate of nintedanib use, time from ILD diagnosis to first nintedanib prescription, and annual rates of nintedanib use by year of Ssc-ILD diagnosis. Results There were 3,467 patients with SSc-ILD (median age at ILD diagnosis: 61 IQR 50-70; female: 2,818 81%; White: 2,010 58%; Black: 528 15%; non-Hispanic: 2308 67%) at 64 healthcare organizations included in our study. Patients had their first ILD visit a median of 97 days (IQR 0-553 days) after their scleroderma diagnosis. There were 105 patients (3.0%) who ever received nintedanib. The median time to nintedanib prescription among those who received a prescription was 195 days (IQR 64-391 days). The annual rate of nintedanib uptake increased significantly from 0.5% to 3.8% (p for trend=0.003) from 2016-2023 (Figure). Conclusions The rate of nintedanib uptake for SSc-ILD was low overall but increased significantly from 2016-2023 in a nationally representative, all-payer database. This upward trend in uptake likely reflects changes in clinical practice following 2019 clinical trial data publication support supporting the efficacy of nintedanib for slowing lung function decline in SSc-ILD. Future work should identify barriers contributing to low uptake and develop targeted strategies to improve implementation of nintedanib among SSc-ILD populations. This abstract is funded by: No funding
Fadel et al. (Fri,) studied this question.