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Immunosuppression does not prevent severe gastrointestinal tract involvement in systemic sclerosis


1, 2, 3, 4, 5, 6, 7, 8, 9, 10

 

  1. Division of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, and Department of Medicine, Université de Montreal, Quebec, Canada.
  2. Department of Medicine, McGill University, Montreal, Quebec, and Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada.
  3. Department of Medicine, Université de Montreal, Quebec, and Division of Rheumatology, Centre Hospitalier de l’Université de Montréal, Quebec, Canada.
  4. Rheumatology Unit, Royal Adelaide Hospital, Adelaide, and Discipline of Medicine, University of Adelaide, South Australia.
  5. Rheumatology, St. Vincent Hospital, Melbourne, Fitzroy, Victoria, Australia.
  6. Rheumatology, St. Vincent Hospital, Melbourne, Fitzroy, Victoria, and Department of Medicine, University of Melbourne at St Vincent Hospital, Melbourne, Victoria, Australia.
  7. Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
  8. Faculty of Pharmacy and School of Public Health, Université de Montreal, Quebec, Canada.
  9. Department of Medicine, McGill University, Montreal, Quebec, and Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada.
  10. Department of Medicine, McGill University, Montreal, Quebec; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada. marie.hudson@mcgill.ca

Canadian Scleroderma Research Group (CSRG), Australian Scleroderma Interest Group (ASIG)

CER14124
2021 Vol.39, N°4 ,Suppl.131
PI 0142, PF 0148
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PMID: 34128797 [PubMed]

Received: 18/10/2020
Accepted : 19/01/2021
In Press: 09/06/2021
Published: 28/07/2021

Abstract

OBJECTIVES:
We aimed to test the hypothesis that exposure to immunosuppression in early systemic sclerosis (SSc) could modify the risk of developing new onset severe gastrointestinal (GIT) involvement.
METHODS:
A total of 762 subjects with <3 years of disease duration and without severe GIT disease at baseline study visit were identified from combined longitudinal cohort data from the Canadian Scleroderma Research Group (CSRG) and Australian Scleroderma Interest Group (ASIG). The primary exposure was ever use of methotrexate, cyclophosphamide, mycophenolate mofetil and/or azathioprine during the study period. Severe GIT disease was defined as: 1-malabsorption, 2-hyperalimentation, 3-pseudo-obstruction, and/or 4-≥10% weight loss in association with the use of antibiotics for bacterial overgrowth or oesophageal stricture. The change in the hazard of severe GIT disease due to exposure was estimated using a marginal structural Cox proportional hazards model fit by inverse probability of treatment weights (IPTW) to address potential confounding.
RESULTS:
Study subjects were 81.5% female, had a mean age of 53.7±13.0 years and mean disease duration at baseline of 1.4±0.8 years. During a mean follow-up of 4.0±2.6 years, severe GIT involvement developed in 11.6% of the 319 subjects exposed to immunosuppression and in 6.8% of the 443 unexposed subjects. In an IPTW-adjusted analysis, exposure to immunosuppression was not associated with severe GIT disease (weighted hazard ratio 0.91, 95% confidence interval 0.52-1.58).
CONCLUSIONS:
In this large inception SSc cohort, the risk of severe GIT involvement was not modified by exposure to immunosuppression.

Rheumatology Article