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.”
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