Temporal trends in vascular medication use in 8079 patients with systemic sclerosis: insights to inform future trials and therapeutic strategies from the EUSTAR cohort
Stefano Di Donato, John D Pauling, Sheila Ramjug, Yannick Allanore, Edward B. Jude, Marie‐Elise Truchetet, Paolo Airó, L. P. Ananyeva, Andra Bălănescu, Gonçalo Boleto, Francesco Paolo Cantatore, Patricia E. Carreira, Carolina de Souza Müller, Masataka Kuwana, Gianluca Moroncini, Marco Di Battista, Luc Mouthon, Madelon C Vonk, Elisabetta Zanatta, Marco Matucci‐Cerinic, Francesco Del Galdo, Michael Hughes, EUSTAR Collaborators, Serena Guiducci, Silvia Bellando-Randone, Ulrich A. Walker, Florenzo Iannone, Oliver Distler, Radim Bečvář, Otylia Kowal Bielecka, Maurizio Cutolo, Vasiliki Liakouli, Elise Siegert, Simona Rednic, Jérôme Avouac, Carlomaurizio Montecucco, László Czirják, Michele Iudici, Katja Perdan Pirkmajer, Bernard Coleiro, Dominique Farge Bancel, Kristofer Andréasson, Mislav Radić, Alexandra Balbir‐Gurman, Nicolas Hunzelmann, Luca Idolazzi, Christopher Denton, Jörg Henes, Vera Ortiz-Santamaria, Johannes Pflugfelder, Dorota Krasowska, Ivan Foeldvari, José António Pereira da Silva, Bojana Stamenkovic, Maria De Santis, Lidia P Ananieva, Philipp Klemm, Ulf Müller-Ladner, Klaus Søndergaard, Simone Negrini, G. Szücs, Anna-Maria Hoffmann-Vold, David Launay, Valeria Riccieri, Ana Maria Gheorghiu, Christina Bergmann, Francesca Ingegnoli, Vanessa Smith, Mette Mogensen, Maria Rosa Pozzi, Felix Lauffer, Marie Vanthuyne, Juan Jose Alegre-Sancho, Martin Aringer, Ellen De Langhe, Branimir Ani, Sule Yavuz, Svetlana Agachi, Alberto Cauli, Kamal Solanki, Esthela Loyo, Edoardo Rosato, Figen Yargucu Zhini, Rosario Foti, Britta Maurer, Marzena Olesinska, Jorge Juan González Martín, Emmanuel Chatelus, Ira Litinsky, Lesley Ann Saketkoo, Eduardo Kerzberg, Breno Valdetaro Bianchi, Ivan Castellví, Massimiliano Limonta, Maura Couto, Camillo Ribi, Antonella Marcoccia, Thierry Martin, Lorinda S Chung, Tim Schmeiser
Abstract
OBJECTIVES: Systemic sclerosis (SSc) is characterized by widespread vascular damage resulting in digital and systemic vasculopathic sequelae. Although there are effective treatments available, vascular disease remains a significant cause of morbidity and mortality in SSc. Our aim was to describe patterns of vascular medication use in SSc, including examination for potential changes over time. METHODS: A cross-sectional study of SSc patients enrolled in the EUSTAR database meeting 2013 ACR/EULAR SSc criteria. Patients were divided into two time periods: 2012-2017 and 2018-2022. We analysed the prescription patterns of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5i), calcium channel blockers (CCB), intravenous iloprost, and antiplatelet therapies. Logistic regression was used to evaluate temporal trends and interaction effects. RESULTS: A total of 8079 patients were included. Significant increases over time were observed in the use of ERA (7% to 12%, P < 0.001), PDE5i (5.4% to 7.2%, P = 0.064), CCB (20% to 32%, P < 0.001) and anti-platelet therapies (15% to 20%, P < 0.001). There was a notable decrease in iloprost use (3.1% to 0.3%, P < 0.001). The prevalence of active digital ulcers (DU) decreased (16% to 13%, P = 0.040), while a history of DU (24% to 30%, P < 0.001) increased. Year-by-year and non-linear increases were noted for ERA and CCB whereas non-linear increase was observed for PDE5i. Year-by-year and non-linear decrease was observed for Iloprost prescription. CONCLUSION: A significant change has occurred over time in vascular medication use in SSc patients, with increased utilization of ERA, PDE5i, CCB and anti-platelet therapies suggesting the adoption of more proactive and/or preventive treatment strategies.