OJRA  Vol.4 No.4 , November 2014
Estimating Benefits from Immunesuppressive Treatment in Diffuse Cutaneous Systemic Sclerosis: Data from the Canadian Scleroderma Research Group
Abstract: Objective: To determine the efficacy of immunesuppressive treatment over 1 year in early diffuse cutaneous systemic sclerosis (dcSSc). Methods: dcSSc patients with less than 3 years disease duration and at least one year of data enrolled in the CSRG database were included. Regression analyses for achieving at least minimal important differences (MID) for 5 outcomes over one year were done to determine baseline predictors of change and if immunesuppressive treatment yielded the attainment of the MID. Results: 124 patients (mean age 52.3 years; 79.2% female) were included. Variables associated with MID at one year were often the baseline variable and for some outcomes, age, sex, smoking, restrictive lung disease and treatment type. Treatment with immunesuppressive was not found to be associated with achieving MIDs in multivariate analyses. Conclusion: Treatment was associated with achieving a MID change at 1 year using univariate statistics, but not in multivariate models. These observational data do not support improvement with immunesuppressives over one year but there could be confounding or biases comparing with those prescribed immunesuppressives vs. those who don’t.
Cite this paper: Choy, T. , Baron, M. and Pope, J. (2014) Estimating Benefits from Immunesuppressive Treatment in Diffuse Cutaneous Systemic Sclerosis: Data from the Canadian Scleroderma Research Group. Open Journal of Rheumatology and Autoimmune Diseases, 4, 248-253. doi: 10.4236/ojra.2014.44034.

[1]   Merkel, P.A., Silliman, N.P., Clements, P.J., Denton, C.P., Furst, D.E., Mayes, M.D., et al. (2012) Patterns and Predictors of Change in Outcome Measures in Clinical Trials in Scleroderma: An Individual Patient Meta-Analysis of 629 Subjects with Diffuse Cutaneous Systemic Sclerosis. Arthritis & Rheumatism, 64, 3420-3429.

[2]   Hudson, M., Steele, R., Lu, Y., Thombs, B.D., Panopalis, P., Baron, M., et al. (2009) Clinical Correlates of Self-Reported Physical Health Status in Systemic Sclerosis. The Journal of Rheumatology, 36, 1226-1229.

[3]   Pope, J. (2011) Measures of Systemic Sclerosis (Scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), Physician-and Patient-Rated Global Assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler’s Index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud’s Condition Score (RCS). Arthritis Care & Research (Hoboken), 63, S98-S111.

[4]   Beaton, D.E., Boers, M. and Wells, G.A. (2002) Many Faces of the Minimal Clinically Important Difference (MCID): A Literature Review and Directions for Future Research. Current Opinion in Rheumatology, 14, 109-114.

[5]   Khanna, D., Furst, D.E., Hays, R.D., Park, G.S., Wong, W.K., Seibold, J.R., et al. (2006) Minimally Important Difference in Diffuse Systemic Sclerosis: Results from the D-Penicillamine Study. Annals of the Rheumatic Diseases, 65, 1325-1329.

[6]   Sekhon, S. and Pope, J., Canadian Scleroderma Research Group and Baron M. (2010) The Minimally Important Difference in Clinical Practice for Patient-Centered Outcomes Including Health Assessment Questionnaire, Fatigue, Pain, Sleep, Global Visual Analog Scale, and SF-36 in Scleroderma. The Journal of Rheumatology, 37, 591-598.

[7]   Lawrence, E., Pope, J., Al-Zahraly, Z., Lalani, S. and Baron, M. (2009) The Relationship between Changes in Self-Reported Disability (Measured by the Health Assessment Questionnaire—HAQ) in Scleroderma and Improvement of Disease Status in Clinical Practice. Clinical and Experimental Rheumatology, 27, 32-37.

[8]   Khanna, D., Yan, X., Tashkin, D.P., Furst, D.E., Elashoff, R., Roth, M.D., et al. (2007) Impact of Oral Cyclophosphamide on Health-Related Quality of Life in Patients with Active Scleroderma Lung Disease: Results from the Scleroderma Lung Study. Arthritis & Rheumatism, 56, 1676-1684.

[9]   Soliman, M.M., Hyrich, K.L., Lunt, M., Watson, K.D., Symmons, D.P., Ashcroft, D.M., et al. (2012) Effectiveness of Rituximab in Patients with Rheumatoid Arthritis: Observational Study from the British Society for Rheumatology Biologics Register. The Journal of Rheumatology, 39, 240-246.

[10]   Jordan, S., Distler, J.H., Maurer, B., Huscher, D., van Laar, J.M., Allanore, Y., et al. (2014) Effects and Safety of Rituximab in Systemic Sclerosis: An Analysis from the European Scleroderma Trial and Research (EUSTAR) Group. Annals of the Rheumatic Diseases, Published Online First 17 January 2014.

[11]   Gazi, H., Pope, J., Clements, P., Medsger, T., Martin, R., Kahaleh, B., et al. (2007) Outcome Measurements in Scleroderma. The Journal of Rheumatology, 34, 501-509.