Immunosuppressive, anti-fibrotic drugs not tied to worsening GI symptoms in early SSc
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PHILADELPHIA — Immunosuppressive or anti-fibrotic drugs do not appear to have any clear impact on worsening gastrointestinal symptoms in patients with early systemic sclerosis, according to data presented at ACR Convergence 2022.
“It is important to understand a little bit more about the pathogenicity because these symptoms can be really troublesome for patients, and so if we can understand the root cause, it helps us to better treat the patient,” Sarah Luebker, DO, a rheumatology fellow at Vanderbilt University Medical Center, in Nashville, told Healio. “I think understanding that can help us with symptoms that could be hard to delineate if it is from the medications or from the disease itself.”
To examine the association between medication use and gastrointestinal tract symptoms in patients with SSc, Luebker and colleagues analyzed data from 399 patients enrolled in the Collaborative National Quality and Efficacy Registry (CONQUER) registry. Inclusion criteria for this analysis were CONQUER participants who had completed a minimum of two serial Scleroderma Clinical Trials Consortium University of California Los Angeles Gastrointestinal Tract questionnaires (GIT 2.0) and the resource utilization questionnaire (RUQ).
Patients were grouped based on total GIT 2.0 severity category change from baseline to subsequent visit. The categories included none-to-mild, defined as 0.49; moderate, defined as 0.5 to 1; and severe-to-very severe, or 1.01 to 3. Four additional categories related to change included no change (none-to-mild), improvement in category, worsening in category and no change (moderate-to-severe).
The RUQ included data on visits to health professionals, diagnostic procedures, purchased aids, alternative treatments, outpatient procedures and surgeries, hospitalization, rehabilitation or nursing home admission, time spent seeing physicians or other health professionals, medical tests and needs of an accompanying individual.
According to the researchers, 52% of the patients demonstrated stable mild gastrointestinal tract symptoms at all observed clinical assessments. The presence of digital ulcers and gastric antral vascular ectasia were not associated with category change. In addition, patients with persistently severe gastrointestinal tract symptoms used the most resources, specifically visits to health professionals, endoscopy, colonoscopy, mobility aids and inpatient hospitalization.
Researchers noted that weight loss, reflux and promotility medications, and particularly tobacco use significantly increased the odds of a worse GIT score, but anti-fibrotic or immunosuppressive drugs did not.
“The main two messages I’d love for people to take away from this research is that early referral to centers of excellence is key for these patients,” Luebker said. “The second is that, even in primary care settings, really focusing on tobacco cessation, and continuing that in our specialty clinics, such as rheumatology, is of utmost importance.”
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Luebker S. Abstract 1053. Presented at: ACR Convergence 2022; Nov. 11-14, 2021; Philadelphia (hybrid meeting).
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