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Abstract Number: 1682

Mycophenolate Mofetil Versus Azathioprine in Scleroderma-Associated Interstitial Lung Disease: Results from the Australian Scleroderma Cohort Study

Claire Owen1, Gene Ngian2, Kathleen Elford2, Owen Moore3, Mandy Nikpour3, Wendy Stevens3, Susanna Proudman4, Janet Roddy5, Jane Zochling6, Catherine Hill7, Peter Nash8, Allan Sturgess9 and Joanne Sahhar2, 1Rheumatology, Monash Health, Melbourne, Australia, 2Monash Health, Melbourne, Australia, 3St Vincent's Hospital, Melbourne, Australia, 4Royal Adelaide Hospital, Adelaide, Australia, 5Royal Perth Hospital, Perth, Australia, 6Department of Rheumatology, Menzies Research Institute Tasmania, Hobart, TAS, Australia, 7Queen Elizabeth Hospital, Adelaide, Australia, 8Sunshine Coast Rheumatology, Maroochydore, Australia, 9The St George Hospital, Sydney, Australia

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: azathioprine, interstitial lung disease, mycophenolate mofetil, scleroderma and systemic sclerosis

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Session Information

Session Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics: Systemic Sclerosis, Diagnostic and Therapeutic Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is common and when progressive, associated with significant morbidity and mortality. Cyclophosphamide is frequently used as first line therapy but evidence is lacking for sustained benefit and toxicity remains a concern. Consequently, patients are often switched to azathioprine (AZA) for maintenance therapy.

We report the efficacy and tolerability of mycophenolate mofetil (MMF) in the management of SSc-ILD and compare this with AZA.

Methods:

Patients in the Australian Scleroderma Cohort Study treated with at least 3 months of MMF or AZA for SSc-ILD confirmed on high resolution computed tomography were identified. Pulmonary function tests (absolute and percent predicted values) at 6-monthly intervals were retrieved. Stability was defined as <10% change in absolute forced vital capacity (FVC), whilst ≥10% increase or decrease defined improvement or decline respectively.

The Wilcoxon sign-rank test was used to compare lung function at 12 months prior to commencement (T-1), baseline (T0), 12 months (T1) and 24 months (T2).

Results:

17 and 49 patients were treated with MMF or AZA for a mean of 3.7±1.4 and 3.8±3.1 years, respectively, with 66% of both groups previously treated with cyclophosphamide. Patients were treated with an average MMF dose of 1.57g/day and AZA of 100mg/day.

Mean age at commencement was 54.6±9.3 years for MMF and 52.9±12.9 years for AZA (p=0.23). Patients in both groups were predominantly female and Caucasian with long-standing disease (10.9±3.7 years for MMF vs. 12.7±7.3 years for AZA, p=0.28). Disease was diffuse in 65% of patients on MMF and 51% on AZA.

Median absolute FVC at T-1 for MMF treatment was 2.5L, declining to 2.3L at T0 (p=0.02). At T1 and T2, FVC was stable at 2.1L (p=0.63) and 2.1L (p=0.93). Median absolute diffusion capacity (DLCO) also demonstrated decline prior to treatment (12.2 to 9.8, p=0.03), with stability at T1 (10.4, p=0.83) and T2 (11.9, p=0.04). Stability or improvement was seen at T1 in 12/15 and T2 in 9/11 cases. Comparable efficacy was achieved with AZA (16/19 cases were stable or improved at T1 and 14/19 at T2).

Adverse events leading to discontinuation were less common in the MMF group (2/17 vs. 13/49). Gastrointestinal complications were the main cause for discontinuation in both groups.

Conclusion:

In patients with SSc-ILD with declining pulmonary function, MMF treatment was associated with stability in FVC and DLCO comparable to AZA and was better tolerated, suggesting a potentially superior role as maintenance therapy.


Disclosure:

C. Owen,
None;

G. Ngian,
None;

K. Elford,
None;

O. Moore,
None;

M. Nikpour,
None;

W. Stevens,
None;

S. Proudman,
None;

J. Roddy,
None;

J. Zochling,
None;

C. Hill,
None;

P. Nash,
None;

A. Sturgess,
None;

J. Sahhar,
None.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mycophenolate-mofetil-versus-azathioprine-in-scleroderma-associated-interstitial-lung-disease-results-from-the-australian-scleroderma-cohort-study/

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