TY - JOUR
T1 - Efficacy, safety, and tolerability of treatments for systemic sclerosis-related interstitial lung disease
T2 - A systematic review and network meta-analysis
AU - Erre, Gian Luca
AU - Sebastiani, Marco
AU - Fenu, Maria Antonietta
AU - Zinellu, Angelo
AU - Floris, Alberto
AU - Cavagna, Lorenzo
AU - Renzoni, Elisabetta
AU - Manfredi, Andreina
AU - Passiu, Giuseppe
AU - Woodman, Richard John
AU - Mangoni, Arduino Aleksander
PY - 2020/8
Y1 - 2020/8
N2 - Background: There is a paucity of head-to-head comparisons of the efficacy and harms of pharmacological treatments for systemic sclerosis-related interstitial lung disease (SSc-ILD). Methods: We conducted a network meta-analysis (NMA) in order to compare the effects of different treatments with the placebo on change in forced vital capacity (FVC), change in diffusion lung capacity for CO (DLCO), serious adverse events (SAEs), discontinuation for adverse events and mortality in SSc-ILD. Standardized mean difference (SMD) and log odds ratio were estimated using NMA with fixed effects. Results: Nine randomized clinical trials (926 participants) comparing eight interventions and the placebo for an average follow-up of one year were included. Compared to the placebo, only rituximab significantly reduced FVC decline (SMD (95% CI) = 1.00 (0.39 to 1.61)). Suitable data on FVC outcome for nintedanib were not available for the analysis. No treatments influenced DLCO. Safety and mortality were also not different across treatments and the placebo, although there were few reported events. Cyclophosphamide and pomalidomide were less tolerated than the placebo, mycophenolate, and nintedanib. Conclusion: Only rituximab significantly reduced lung function decline compared to the placebo. However, direct head-to-head comparison studies are required to confirm these findings and to better determine the safety profile of various treatments.
AB - Background: There is a paucity of head-to-head comparisons of the efficacy and harms of pharmacological treatments for systemic sclerosis-related interstitial lung disease (SSc-ILD). Methods: We conducted a network meta-analysis (NMA) in order to compare the effects of different treatments with the placebo on change in forced vital capacity (FVC), change in diffusion lung capacity for CO (DLCO), serious adverse events (SAEs), discontinuation for adverse events and mortality in SSc-ILD. Standardized mean difference (SMD) and log odds ratio were estimated using NMA with fixed effects. Results: Nine randomized clinical trials (926 participants) comparing eight interventions and the placebo for an average follow-up of one year were included. Compared to the placebo, only rituximab significantly reduced FVC decline (SMD (95% CI) = 1.00 (0.39 to 1.61)). Suitable data on FVC outcome for nintedanib were not available for the analysis. No treatments influenced DLCO. Safety and mortality were also not different across treatments and the placebo, although there were few reported events. Cyclophosphamide and pomalidomide were less tolerated than the placebo, mycophenolate, and nintedanib. Conclusion: Only rituximab significantly reduced lung function decline compared to the placebo. However, direct head-to-head comparison studies are required to confirm these findings and to better determine the safety profile of various treatments.
KW - Cyclophosphamide
KW - Hematopoietic stem-cell transplantation
KW - Interstitial lung disease
KW - Mycophenolate mofetil
KW - Network meta-analysis
KW - Nintedanib
KW - Pomalidomide
KW - Randomized controlled trials
KW - Rituximab
KW - Systemic sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85100610646&partnerID=8YFLogxK
U2 - 10.3390/jcm9082560
DO - 10.3390/jcm9082560
M3 - Review article
AN - SCOPUS:85100610646
SN - 2077-0383
VL - 9
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 8
M1 - 2560
ER -