ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 831

Immunosuppression May Prevent Interstitial Lung Disease in Systemic Sclerosis

Sabrina Hoa1, Marie Hudson2, Mianbo Wang3, Russell Steele4, Murray Baron5 and Canadian Scleroderma Research Group, 1Division of Rheumatology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada, 2Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, QC, Canada, 3Lady Davis Institute for Medical Research, Montreal, QC, Canada, 4Mathematics, McGill University, Montreal, QC, Canada, 5Rheumatology, McGill University, Jewish General Hospital, Montreal, QC, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: immunosuppressants, interstitial lung disease, prevention and systemic sclerosis

  • Tweet
  • Email
  • Print
Session Information

Date: Sunday, November 13, 2016

Session 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

Background/Purpose: Interstitial lung disease (ILD) is a leading cause of premature mortality in systemic sclerosis (SSc). Immunosuppression is used for treatment of established disease. However, little is known about whether immunosuppression might prevent ILD in SSc. The aim of this study was to determine if, in SSc patients without ILD, immunosuppression (given for other manifestations) was associated with a lower risk of new onset SSc-ILD.

Methods: A retrospective cohort of 887 SSc patients without ILD at baseline was studied, using data from the Canadian Scleroderma Research Group registry. The primary exposure of interest was immunosuppression with methotrexate, cyclophosphamide, mycophenolate and/or azathioprine. The primary outcome variable was new onset ILD defined using a published algorithm (Steele, ACR 2012). Time to primary outcome was compared between exposed and unexposed subjects, modeled as a time-dependent exposure variable, using an unadjusted Kaplan-Meier model and a marginal structural model incorporating inverse probability of treatment weights (IPTW) to account for confounding. Weights were constructed using variables most likely to influence a decision to initiate immunosuppression, namely age, sex, ethnicity, disease duration, anti-centromere, anti-topoisomerase I, and anti-RNA polymerase III status, modified Rodnan skin scores, C-reactive protein levels, forced vital capacity, presence of inflammatory arthritis, presence of inflammatory myositis, and exposure to immunosuppressive therapy in the past. Subjects were censored at the visit when ILD was first recorded, or time of death, permanent study drop-out or last study visit. Both robust asymptotic and non-parametric bootstrap confidence intervals were constructed.

Results: The study included 218 subjects exposed to immunosuppression at baseline or during follow up and 669 unexposed subjects. Baseline characteristics of exposed and unexposed subjects are presented in Table 1. In unadjusted Kaplan Meier analysis, the observed risk of ILD was higher in exposed compared to unexposed subjects (log rank p <.0001), consistent with confounding. However, in a multivariate analysis incorporating IPTW, subjects exposed to immunosuppression had a lower estimated risk of developing ILD compared to unexposed subjects: weighted hazard ratio (HR) 0.50 (95% CI 0.28, 0.90, p=0.021), and, after bootstrapping, 0.50 (95% CI 0.17, 0.99).

Conclusion: To our knowledge, this is the first study to demonstrate a role for immunosuppression in preventing SSc-ILD in an observational cohort using modern causal statistical methods. In subjects perceived to be at increased risk for developing ILD, there may be value in initiating immunosuppression early, as this may alter disease course and potentially outcomes. Table 1. Baseline characteristics of the cohort separated by exposure status (N=887)

Non-exposure to treatments (N=669)

Exposure to treatments (N=218)

p values

Mean (SD) or N (%)

Missing

Mean (SD) or N (%)

Missing

Female

601 (89.8%)

0

186 (85.3%)

0

0.067

Age, years

55.4 (12.0)

0

50.8 (12.3)

0

<.001

Disease duration from first non-Raynaud, years

11.3 (9.5)

2

6.6 (7.5)

0

<.001

Caucasian

567 (88.3%)

27

173 (83.6%)

11

0.076

Current or ever smoking

399 (62.0%)

25

117 (56.0%)

9

0.125

Modified Rodnan skin score (0-51)

7.0 (7.7)

10

13.7 (10.8)

3

<.001

Anti-centromere, %

307 (51.3%)

71

54 (29.2%)

33

<.001

Anti-topoisomerase, %

55 (9.2%)

71

38 (20.5%)

33

<.001

Anti-RNA polymerase III, %

67 (11.2%)

71

43 (23.2%)

33

<.001

Erythrocyte sedimentation rate, mm/hr

18.8 (18.4)

79

22.0 (20.9)

33

0.067

C-reactive protein, mg/L

7.1 (14.2)

119

9.5 (19.0)

52

0.014

FVC, % predicted

97.9 (16.3)

77

92.6 (18.1)

25

<.001

TLC, % predicted

99.3 (15.1)

112

96.6 (16.2)

39

0.016

DLCO, % predicted

75.0 (18.6)

132

72.2 (19.7)

51

0.091

Inflammatory arthritis

167 (25.8%)

21

92 (43.4%)

6

<.001

Myositis

39 (5.9%)

3

39 (18.1%)

2

<.001

Exposure to immunosuppression prior to baseline

47 (7.0%)

1

39 (17.9%)

0

<.001


Disclosure: S. Hoa, None; M. Hudson, None; M. Wang, None; R. Steele, None; M. Baron, None.

To cite this abstract in AMA style:

Hoa S, Hudson M, Wang M, Steele R, Baron M. Immunosuppression May Prevent Interstitial Lung Disease in Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/immunosuppression-may-prevent-interstitial-lung-disease-in-systemic-sclerosis/. Accessed June 28, 2022.
  • Tweet
  • Email
  • Print

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunosuppression-may-prevent-interstitial-lung-disease-in-systemic-sclerosis/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2022 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies