‘Aggressive’ treatment of GERD improves survival in systemic sclerosis with ILD
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Key takeaways:
- Proton pump inhibitors with histamine 2 receptor antagonists reduced all-cause mortality in patients with SSc-ILD.
- Combination therapy outperformed single-agent treatment for improved survival.
“Aggressive” combination therapy for gastroesophageal reflux disease improved survival among patients with systemic sclerosis and interstitial lung disease, according to data published in Arthritis Research & Therapy.
“ILD is the leading cause of death in SSc with some studies showing an association between the presence of [gastroesophageal reflux disease (GERD)] and/or esophageal dysmotility and ILD,” Alannah Quinlivan, MBBS, FRACP, of the department of rheumatology at St. Vincent’s Hospital, in Melbourne, Australia, and colleagues wrote. “Treatment of GERD with proton pump inhibitors (PPI) or histamine 2 receptor antagonists (H2RA) is recommended by the gastroenterological society guidelines and SSc specific guidelines. Whether these medications impact ILD development or progression is unknown.”
To assess the impact of GERD and its treatment on ILD in patients with SSc, Quinlivan and colleagues analyzed data from the Australian Scleroderma Cohort Study. Their analysis included 1,632 patients with SSc (mean age at onset, 47.4 years), 29% (n = 469) of whom had ILD.
Specifically, the researchers examined whether the presence of GERD impacted ILD severity, as well as the length of time from first non-Raynaud’s sign of disease to development of ILD. Quinlivan and colleagues assessed ILD severity as the percentage of fibrosis measured on chest high-resolution CT. The researchers also evaluated how different GERD treatments — either PPI alone or in combination with H2RA — impacted survival.
Overall, GERD affected 94% of the study population (n = 1,539) and 96% of those with ILD. According to the researchers, he analysis revealed no relationship between GERD or its treatment to ILD development or severity. However, GERD treatment was linked to improved survival among patients with ILD (P = .002), especially with PPI and H2RA combination therapy (HR = 0.5; 95% CI, 0.3-0.9) vs. PPI alone (HR = 0.3; 95% CI, 0.2-0.6).
“Our study shows that the use of anti-reflux medication for the management of GERD in SSc-ILD is associated with a survival benefit,” Quinlivan and colleagues wrote. “... We found that aggressive management of GERD in SSc-ILD (with combination PPI and H2RA) was associated with improved survival compared to single agent therapy with PPI alone.
“Whilst we are not recommending the empiric use of anti-reflux therapy in all SSc patients, we are highlighting that in those with GERD and SSc-ILD, the treatment of GERD with PPI or combination PPI/H2RA is associated with improved survival, and in this context, benefits of treatment may outweigh potential risks,” they added. “We acknowledge that the H2RA ranitidine has been withdrawn from the market due to the presence of N-nitrosodimethylamine (NDMA). However, other H2RA such as nizatidine remain available.”
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