Gastroprotective, promotility agents fail to prevent systemic sclerosis-associated ILD

Gastroprotective and promotility agents do not appear to prevent clinically apparent systemic sclerosis-associated interstitial lung disease, according to results of a large retrospective cohort study.

“Given the potential association between GERD and progressive systemic sclerosis-associated ILD, treatment of GERD with gastroprotective agents is recommended in the setting of systemic sclerosis-associated ILD when concomitant GERD is present,” Raphaël Hurtubise, MD, internal medicine resident at Montreal University, and colleagues wrote in Respiratory Medicine. “However, it is unknown whether gastroprotective agents can prevent the onset of ILD in systemic sclerosis by reducing reflux acidity, which could be a trigger for developing ILD, and whether these agents should be used for this indication in the absence of overt GERD symptoms.”

The retrospective cohort study included 798 individuals (mean age, 54.9 years; 89% women) with systemic sclerosis but without clinically apparent ILD at baseline. All were enrolled in the Canadian Scleroderma Research Group registry. Researchers compared time to ILD development between patients who used and did not use gastroprotective agents. The primary outcome was use of any gastroprotective agent; secondary outcomes included treatment with promotility agents.

Median disease duration was 7.6 years.

During a median 4.4 years of follow-up, 158 newly diagnosed ILD cases were observed (crude incidence, 4.4 events per 100 person-years).

Of all person-visits recorded, 73.4% were exposed to gastroprotective agents, 20.4% were exposed to promotility agents and 19.5% were exposed to both gastroprotective and promotility agents. In addition, 95.7% of person-visits exposed to promotility agents were also exposed to gastroprotective agents, according to the results.

Compared with individuals who did not use gastroprotective agents, those exposed to gastroprotective agents had a weighted adjusted HR for incident ILD of 0.86 (95% CI, 0.52-1.41). When exposure was defined as promotility agent treatment, the weighted aHR was 0.79 (95% CI, 0.35-1.77), according to the results.

According to the researchers, this is the largest cohort study to date to evaluate the association between gastroprotective and promotility agents and incident systemic sclerosis-associated ILD.

“Whether [these agents] can mitigate systemic sclerosis-associated ILD progression, however, remains poorly understood and should be further studied,” the researchers wrote.