Anti-acid therapy in SSc-associated interstitial lung disease: long-term outcomes from the German Network for Systemic Sclerosis.

Abstract

OBJECTIVES:

Gastroesophageal reflux disease (GERD) occurs frequently in patients with SSc. We investigated whether the presence of GERD and/or the use of anti-acid therapy, specifically proton-pump inhibitors (PPIs), are associated with long-term outcomes, especially in SSc-associated interstitial lung disease (SSc-ILD).

METHODS:

We retrospectively analysed patients with SSc and SSc-ILD from the German Network for Systemic Sclerosis (DNSS) database (2003 onwards). Kaplan-Meier analysis compared overall survival (OS) and progression-free survival (PFS) in patients with GERD vs without GERD (SSc and SSc-ILD), and PPI vs no PPI use (SSc-ILD only). Progression was defined as a decrease in either percentage predicted forced vital capacity of ≥10% or single-breath diffusing capacity for carbon monoxide of ≥15%, or death.

RESULTS:

It was found that 2693/4306 (63%) registered patients with SSc and 1204/1931 (62%) with SSc-ILD had GERD. GERD was not associated with decreased OS or decreased PFS in patients in either cohort. In SSc-ILD, PPI use was associated with improved OS vs no PPI use after 1 year [98.4% (95% CI: 97.6, 99.3); n = 760 vs 90.8% (87.9-93.8); n = 290] and after 5 years [91.4% (89.2-93.8); n = 357 vs 70.9% (65.2-77.1); n = 106; P < 0.0001]. PPI use was also associated with improved PFS vs no PPI use after 1 year [95.9% (94.6-97.3); n = 745 vs 86.4% (82.9-90.1); n = 278] and after 5 years [66.8% (63.0-70.8); n = 286 vs 45.9% (39.6-53.2); n = 69; P < 0.0001].

CONCLUSION:

GERD had no effect on survival in SSc or SSc-ILD. PPIs improved survival in patients with SSc-ILD. Controlled, prospective trials are needed to confirm this finding.

• Authors: Michael Kreuter, Francesco Bonella, Norbert Blank, Gabriela Riemekasten, Ulf Müller-Ladner, Jörg Henes, Elise Siegert, Claudia Günther, Ina Kötter, Christiane Pfeiffer, Marc Schmalzing, Gabriele Zeidler, Peter Korsten, Laura Susok, Aaron Juche, Margitta Worm, Ilona Jandova, Jan Ehrchen, Cord Sunderkötter, Gernot Keyßer, Andreas Ramming, Tim Schmeiser, Alexander Kreuter, Kathrin Kuhr, Hanns-Martin Lorenz, Pia Moinzadeh, Nicolas Hunzelmann
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 62 Issue 9 Pg. 3067-3074 (09 01 2023) ISSN: 1462-0332 [Electronic] England
• PMID: 36708008 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Chemical References

• Proton Pump Inhibitors

Topics

• Humans
• Retrospective Studies
• Prospective Studies
• Lung Diseases, Interstitial (etiology, complications)
• Scleroderma, Systemic (complications, drug therapy)
• Gastroesophageal Reflux (complications, drug therapy)
• Proton Pump Inhibitors (therapeutic use)
• Lung