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Disease-modifying treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Treatments which modify the progression of systemic sclerosis may be classified into three groups:

  • specific immunosuppressant therapy:
    • cyclosporin A:
      • good for skin but bad for kidneys
    • antithymocyte globulin:
      • good for skin
    • plasmapheresis:
      • anecdotal evidence only
  • global immunosuppressant therapy:
    • methotrexate
    • corticosteroids
    • alkylating agents e.g. azathioprine, cyclophosphamide
    • ritixumab
      • study suggest that rituximab treatment may provide long-term benefit for patients with systemic sclerosis, and serum immunoglobulins should be explored as potential response markers (1)

  • anti-fibrotic therapy:
    • D-penicillamine:
      • good for lung, skin and kidney
    • interferons alpha & gamma:
    • probably beneficial, but morbidity with interferons is significant

Reference:

  • Kuzumi A, Ebata S, Fukasawa T, et al. Long-term Outcomes After Rituximab Treatment for Patients With Systemic Sclerosis: Follow-up of the DESIRES Trial With a Focus on Serum Immunoglobulin Levels. JAMA Dermatol. Published online February 15, 2023. doi:10.1001/jamadermatol.2022.6340

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