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Abstract Number: 843

Forced Vital Capacity Predicts Outcome in Scleroderma Associated Interstitial Lung Disease with Concomitant Pulmonary Hypertension:  Data from the Pharos Registry

Joyce Sujin Lee1, Jessica K. Gordon2, Jackie Szymonifka3, Virginia Steen4 and Aryeh Fischer5, 1SOM-MED, University of Colorado, Denver - Anschutz Medical Campus, Aurora, CO, 2Rheumatology, Hospital for Special Surgery, New York, NY, 3Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, 4Georgetown University School of Medicine, Washington, DC, 5Medicine / Center for Lungs and Breathing, University of Colorado School of Medicine, Aurora, CO

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: interstitial lung disease, pulmonary complications, pulmonary fibrosis and systemic sclerosis

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Session Information

Date: Sunday, November 13, 2016

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud's – Clinical Aspects and Therapeutics - Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Forced vital capacity predicts outcome in scleroderma associated interstitial lung disease with concomitant pulmonary hypertension:  Data from the PHAROS registry

Background/Purpose:   Interstitial lung disease (ILD) is the leading cause of death in scleroderma and is often accompanied by secondary pulmonary hypertension (Group 3 PH).  The objectives of this study were to characterize the Group 3 PH population of PHAROS, compare them to those with Group 1 PH (pulmonary arterial hypertension), and identify specific variables with prognostic significance.

Methods:   PHAROS is a prospective multi-center registry of scleroderma patients at high risk for, or with definite PH based on right heart catheterization (RHC) within six months of enrollment.  In this study, we included those considered by PHAROS investigators to have Group 3 PH as defined by the presence of moderately-severe ILD (as determined by a forced vital capacity [FVC] < 65% predicted and/or significant ILD by chest computed tomography scan) along with RHC-confirmed mean pulmonary artery pressure of ≥ 25 mmHg and pulmonary capillary wedge pressure < 15 mmHg and compared them to PHAROS subjects considered to have Group 1 PH (pulmonary arterial hypertension).  Baseline demographics and clinical characteristics at the time of RHC were assessed, and univariate analyses (STATA, version 14.0) were performed to identify variables predictive of outcome. 

Results:   Sixty-three Group 3 PH patients were identified.  Baseline demographics and clinical characteristics are displayed in the Table.  Patients with Group 3 PH were more likely to be African-American, have diffuse skin involvement, anti-Scl70 positivity and more severe impairment on pulmonary function testing, but with better cardiac hemodynamics.  With a median follow-up period of 913 days (interquartile range 383, 2158), 41% of the Group 3 PH cohort expired; with ILD progression as the most frequent cause of death (12 of 26, 46%).  The 5-year survival was similarly poor for both groups: Group 1 PH 58% vs. Group 3 PH 61%.   On univariate analysis of Group 3 PH patients, the only variable associated with survival time, was FVC (HR 0.967, 95% CI: 0.939-0.997; p=0.03):  the lower the FVC, the higher the risk of death.

Conclusion:   Moderate-severe ILD with concomitant PH is associated with a poor prognosis and the degree of physiologic restriction, as measured by FVC, is associated with worse survival time. 

Group 1 PH

n=214

Group 3 PH

n=63

Age (mean) **

60.3±10.5

52.6±11.1

Female gender

84%

77%

Race % African-American **

11%

25%

Diffuse skin involvement **

26%

45%

Anti-Scl-70 positive **

6%

37%

Isolated nucleolar ANA

24%

19%

Anti-centromere positive

39%

6%

Cigarette smoking history

N/A

36%

History of treatment with MMF or CYC

N/A

56%

Total lung capacity, % predicted **

81.4 (68.8, 91.8)

54.5 (47.9, 61.3)

Forced vital capacity, % predicted **

79.2 (71.1, 90.0)

49.9 (43.1, 58.9)

Diffusing capacity for carbon monoxide, % predicted **

38.8 (31.9, 51.8)

28.2 (22.6, 36.5)

Mean pulmonary artery pressure *

35 (29. 43)

30 (26, 38)

Pulmonary capillary wedge pressure

10 (8, 12)

10 (7, 14)

Cardiac output

5 (3.9, 6.1)

5 (4.6, 5.8)

Pulmonary vascular resistance *

370 (263, 658)

321.5 (223.7, 462.5)

*p<0.01 ** p<0.001 Categorical values are expressed as median (interquartile range) unless otherwise specified


Disclosure: J. S. Lee, None; J. K. Gordon, None; J. Szymonifka, None; V. Steen, None; A. Fischer, Gilead Sciences, 5,Bristol-Myers Squibb, 5,Genentech and Biogen IDEC Inc., 2,Boehringer Ingelheim, 5,Genentech and Biogen IDEC Inc., 5,GlaxoSmithKline, 5,Actelion Pharmaceuticals US, 5,Gilead Sciences, 5,Bristol-Myers Squibb, 5,Boehringer Ingelheim, 2,GlaxoSmithKline, 5,Boehringer Ingelheim, 2.

To cite this abstract in AMA style:

Lee JS, Gordon JK, Szymonifka J, Steen V, Fischer A. Forced Vital Capacity Predicts Outcome in Scleroderma Associated Interstitial Lung Disease with Concomitant Pulmonary Hypertension:  Data from the Pharos Registry [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/forced-vital-capacity-predicts-outcome-in-scleroderma-associated-interstitial-lung-disease-with-concomitant-pulmonary-hypertension-data-from-the-pharos-registry/. Accessed .
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