Role of Gastroprotective, Promotility Agents in SSc-Interstitial Lung Disease

Interstitial lung disease, CT scan
Do gastroprotective and promotility agents prevent incident interstitial lung disease in patients with systemic sclerosis?

Gastroprotective and promotility agents do not prevent incident interstitial lung disease (ILD) in patients with systemic sclerosis (SSc), according to a study published in Respiratory Medicine.

ILD affects 47% to 84% of patients with SSc and is the leading cause of SSc-related mortality. Gastroesophageal reflux disease (GERD) is also present in 50% to 90% of these patients and is a possible risk factor for the incidence, severity, and progression of SSc-ILD.

Researchers sought to determine whether gastroprotective and promotility agents could lower the risk of developing SSc-ILD in SSc patients without clinically apparent ILD, using observational data from the Canadian Scleroderma Research Group (CSRG) registry. A total of 798 subjects met the inclusion criteria and were followed for a median of 4.4 years.

Over the study period, 158 new cases of ILD were diagnosed, representing a crude incidence of 4.4 events per 100 person-years. In addition, 2085 (73.4%) person-visits were exposed to gastroprotective agents with 579 (20.4%) exposed to promotility agents and 554 (19.5%) exposed to both agents. The majority (95.7%) of person-visits exposed to promotility agents were also exposed to gastroprotective agents. Using a multivariable marginal structural Cox analysis, the researchers determined that the weighted adjusted hazard ratio (HR) was 0.86 (95% CI, 0.52-1.41) for incident ILD in subjects exposed to gastroprotective agents and 0.79 (95% CI, 0.35-1.77) in subjects exposed to promotility agents compared with unexposed subjects.

“In conclusion, using a robust bias-reduction method, we were unable to demonstrate a role for gastroprotective and promotility agents in preventing clinically apparent SSc-ILD,” stated the authors. They added, “Whether they can mitigate SSc-ILD progression, however, remains poorly understood and should be further studied.”

Reference

Hurtubise R, Hudson M, Gyger G, et al; Canadian Scleroderma Research Group. Association between gastroprotective agents and risk of incident interstitial lung disease in systemic sclerosis. Respir Med. 2021;185:106482. doi:https://doi.org/10.1016/j.rmed.2021.106482