Sistemik sklerozis ilişkili interstisyel akciğer hastalığının güncel tedavisi
Sistemik skleroz (SSc), deri ve iç organ fibrozisine neden olan ve vaskülopati, immün sistem işlev bozukluğu ile giden bir bağ dokusu hastalığıdır. Sistemik skleroz, sıklıkla birden fazla organı ve/veya sistemi etkilese de akciğer tutulumu ve özellikle de interstisyel akciğer hastalığı (İAH) bu hastalıkta önde gelen ölüm nedenidir. Son yıllarda farklı tedavi seçeneklerinin olması bu hastalığın yönetiminde klinisyenlere umut vermiştir. Bu makalede SSc-İAH’nin güncel tedavi seçenekleri gözden geçirilecektir.
Current treatment of systemic sclerosisassociated interstitial lung disease
Systemic sclerosis (SSc) is a connective tissue disease characterized by immune irregularity, vasculopathy and excessive collagen production, which causes skin and internal organ fibrosis. Although SSc often affects multiple organs and/or systems, lung involvement and especially interstitial lung disease (ILD) are the leading cause of death in this disease. The fact that different treatment options have been raised in recent years has given hope to clinicians in the management of this disease. This article will also review the current treatment options of SSc-ILD.
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- 1. Ferri C, Valentini G, Cozzi F, Sebastiani M, Michelassi C, La Montagna G, et al. Systemic sclerosis: demograhic, clinical, and serologic features and survival in 1012 Italian patients. Medicine 2002; 81(2): 139-53. https://doi. org/10.1097/00005792-200203000-00004
- 2. Steele R, Hudson M, Lo E, Baron M. Canadian scleroderma research group. Clinical decision rule to predict the presence of interstitial lung disease in systemic sclerosis. Arthritis Care Res (Hoboken) 2012; 64: 519-24. https://doi.org/10.1002/acr.21583
- 3. Firestein GS, Budd RC, Harris ED Jr. McInnes IB, Ruddy S. (eds). Kelley’s Textbook of Rheumatology. Volume II. 2005. p.1279-303.
- 4. Harrison NK, Myers AR, Corin B, Soosay G, Dewar A, Black CM, et al. Structural features of interstitial lung disease in systemic sclerosis. Am Rev Respir Dis 1991; 144: 706-13. https://doi.org/10.1164/ajrccm/144.3_Pt_1.706
- 5. Hayman LD, Hunt RE. Pulmonary fibrosis in generalized scleroderma. Dis Chest 1952; 21: 691-704. https://doi. org/10.1378/chest.21.6.691
- 6. Kahaleh MB. Endothelin, an endothelial-dependendent vasoconstrictor in scleroderma. Arthritis Rheum 1991; 34: 978-83. https://doi.org/10.1002/art.1780340807
- 7. Giaid A, Michel RP, Stewart DJ, Sheppard M, Corrin B, Hamid Q. Expression of endothelin1 in lungs of patients with cryptogenic fibrosing alveolitis. Lancet 1993; 341: 1550-4. https://doi.org/10.1016/0140-6736(93)90694-C
- 8. Silver RM, Metcalf JF, Sranley JH, LeRoy EC. Interstitial lung disease in scleroderma. Arthritis Rheum 1984; 27: 1254- 62. https://doi.org/10.1002/art.1780271107
- 9. Ohba T, McDonald JK, Silver RM, Strange C, LeRoy EC, Ludwicka A. Scleroderma bronchoalveolar lavage fluid contains thrombin, a mediator of human lung fibroblast proliferation via induction of platelet-derived growth factor alpha receptor. Am J Respir Cell Mol Biol 1994; 10(4): 405-12. https://doi.org/10.1165/ajrcmb.10.4.7510986
- 10. Jain R, Shaul PW, Borok Z, Willis BC. Endothelin-1 induces alveolar epithelial-mesenchymal transition through endothelin type A receptor mediated production of TGF-beta1. Am J Respir Cell Mol Biol 2007; 37(1): 38-47. https://doi. org/10.1165/rcmb.2006-0353OC
- 11. Varga J, Rosenbloom J, Jimenez SA. Transforming growth factor beta (TGF beta) causes a persistent increase in steady-state amounts of type I and type III collagen and fibronectin mRNAs in normal human dermal fibroblasts. Biochem J 1987; 247(3): 597-604. https://doi. org/10.1042/bj2470597
- 12. Shi Wen X, Rodríguez Pascual F, Lamas S, Holmes A, Howat S, Pearson JD, et al. Constitutive ALK5-independent c-Jun N-terminal kinase activation contributes to endothelin- 1 overexpression in pulmonary fibrosis: evidence of an autocrine endothelin loop operating through the endothelin A and B receptors. Mol Cell Biol 2006; 26(14): 5518- 27. https://doi.org/10.1128/MCB.00625-06
- 13. Horstmeyer A, Licht C, Scherr G, Eckes B, Krieg T. Signalling and regulation of collagen I synthesis by ET-1 and TGF-beta1. FEBS J 2005; 272(24): 6297-309. https:// doi.org/10.1111/j.1742-4658.2005.05016.x
- 14. Tamby MC, Chanseaud Y, Guillevin L, Mouthon L. New insights into the pathogenesis of systemic sclerosis. Autoimmun Rev 2003; 2(3): 152-7. https://doi. org/10.1016/S1568-9972(03)00004-1
- 15. Remy Jardin M, Remy J, Wallaert B, Bataille D, Hatron PY. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology 1993; 188(2):499- 506. https://doi.org/10.1148/radiology.188.2.8327704
- 16. Orens JB, Kazerooni EA, Martiniez FJ, Curtis JL, Gross BH, Flint A, et al. The sensitivity of highresolution CT in detecting idiopathic pulmonary fibrosis proved by open lung biopsy. A prospective study. Chest 1995; 108(1): 109-15. https://doi.org/10.1378/chest.108.1.109
- 17. MacDonald SL, Rubens MB, Hansell DM, Copley SJ, Desai SR, du Bois RM, et al. Nonspesific interstitial pneumonia and usual interstitial pneumonia: comparative appearances at and diagnostic accuracy of thin-section CT. Radiology 2001; 221(3) :600-5. https://doi.org/10.1148/radiol. 2213010158
- 18. Goh NS, Desai SR, Veeraraghavan S, Hansell DM, Copley SJ, Maher TM, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med 2008; 177(11): 1248-54. https://doi.org/10.1164/ rccm.200706-877OC
- 19. Silver RM, Clements PJ. Interstitial lung disease in systemic sclerosis: optimizing evaluation and management. Scleroderma Care Research 2003; 1: 3-11.
- 20. Akesson A, Scheja A, Lundin A, Wollheim FA. Improved pulmonary function in systemic sclerosis after treatment with cyclophosphamide. Arthritis Rheum 1994; 37(5): 729-35. https://doi.org/10.1002/art.1780370518
- 21. Steen VD, Lanz JK Jr, Conte C, Owens GR, Medsger TA Jr. Therapy for severe interstitial lung disease in systemic sclerosis. A retrospective study. Arthritis Rheum 1994; 37(9): 1290-6. https://doi.org/10.1002/art.1780370904
- 22. Pakas I, Ioannidis JP, Malagari K, Skopouli FN, Moutsopoulos HM, Vlachoviannopoulos PG. Cyclophosphamide with low or high dose prednisolone for systemic sclerosis lung disease. J Rheumatol 2002; 29(2): 298-304.
- 23. Griffiths B, Miles S, Moss H, Robertson R, Veale D, Emery P. Systemic sclerosis and interstitial lung disease: a pilot study using pulse intravenous methylprednisolone and cyclophosphamide to assess the effect on high resolution computed tomography scan and lung function. J Rheumatol 2002; 29(11): 2371-8.
- 24. Silver RM, Warrick JH, Kinsella MB, Staudt LS, Baumann MH, Strange C. Cyclophosphamide and low-dose prednisone therapy in patients with systemic sclerosis (scleroderma) with interstitial lung disease. J Rheumatol 1993; 20: 838-44.
- 25. White B, Moore WC, Wigley FM, Xiao HQ, Wise RA. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma and alveolitis. Ann Intern Med 2000; 132: 947-54. https://doi. org/10.7326/0003-4819-132-12-200006200-00004
- 26. Hoyles RK, Ellis RW, Wellsbury J, Lees B, Newlands P, Goh NS, et al. A multicenter, prospective, randomized, double- blind, placebo-controlled trial of corticosteroids and intravenous cyclophosphamide followed by oral azathioprine for the treatment of pulmonary fibrosis in scleroderma. Arthritis Rheum 2006; 54: 3962-70. https://doi. org/10.1002/art.22204
- 27. Tashkin DP, Elashoff R, Clements PJ, Goldin J, Roth MD, Furst DE, et al. Scleroderma Lung Study Research Group. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med 2006; 354: 2655-66. https://doi. org/10.1056/NEJMoa055120
- 28. Tashkin DP, Elashoff R, Clements PJ, Roth MD, Furst DE, Silver RM, et al. Scleroderma Lung Study Research Group. Effects of 1-year treatment with cyclophosphamide on outcomes at 2 years in scleroderma lung disease. Am J Respir Crit Care Med 2007; 176(10): 1026-34. https:// doi.org/10.1164/rccm.200702-326OC
- 29. Zamora AC, Wolters PJ, Collard HR, Connolly MK, Elicker BM, Webb WR, et al. Use of mycophenolate mofetil to treat scleroderma-associated interstitial lung disease. Respirat Med 2008; 102(1): 150-5. https://doi. org/10.1016/j.rmed.2007.07.021
- 30. Derk CT, Grace E, Shenin M, Naik M, Schulz S, Xiong W. A prospective open-label study of mycophenolate mofetil for the treatment of diffuse systemic sclerosis. Rheumatology (Oxford) 2009; 48: 1595-9. https://doi. org/10.1093/rheumatology/kep295
- 31. Koutroumpas A, Ziogas A, Alexiou I, Barouta G, Sakkas LI. Mycophenolate mofetil in systemic sclerosis-associated interstitial lung disease. Clin Rheumatol 2010; 29(10): 1167-8. https://doi.org/10.1007/s10067-010-1498-z
- 32. Simeón Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Selva- O’Callaghan A, Solans-Laqué R, Vilardell-Tarrés M. Effect of mycophenolate sodium in scleroderma-related interstitial lung disease. Clin Rheumatol 2011; 30(11): 1393-8. https://doi.org/10.1007/s10067-011-1823-1
- 33. Yilmaz N, Can M, Kocakaya D, Karakurt S, Yavuz S. Twoyear experience with mycophenolate mofetil in patients with scleroderma lung disease: a case series. Int J Rheum Dis 2014; 17(8): 923-8. https://doi.org/10.1111/1756- 185X.12399
- 34. Tashkin DP, Roth MD, Clements PJ, Furst DE, Khanna D, Kleerup EC, et al. Scleroderma Lung Study II Investigators. Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease: Scleroderma Lung Study II (SLS-II), a double-blind, parallel group, randomised controlled trial. Lancet Respir Med 2016; 4: 708- 19. https://doi.org/10.1016/S2213-2600(16)30152-7
- 35. Nadashkevich O, Davis P, Fritzler M, Kovalenko W. A randomized unblinded trial of cyclophosphamide versus azathioprine in the treatment of systemic sclerosis. Clin Rheumatol 2006; 25(2): 205-12. https://doi.org/10.1007/ s10067-005-1157-y
- 36. Dheda K, Lalloo UG, Cassim B, Mody GM. Experience with azathioprine in systemic sclerosis associated with interstitial lung disease. Clin Rheumatol 2004; 23(4): 306- 9. https://doi.org/10.1007/s10067-004-0906-7
- 37. Daoussis D, Liossis SN, Tsamandas AC, Kalogeropoulou C, Paliogianni F, Sirinian C, et al. Effect of long-term treatment with rituximab on pulmonary function and skin fibrosis in patients with diffuse systemic sclerosis. Clin Exp Rheumatol 2012;30(2, Suppl 71):S17-S22.
- 38. Bosello SL, De Luca G, Rucco M, Berardi G, Falcione M, Danza FM, et al. Long-term efficacy of B cell depletion therapy on lung and skin involvement in diffuse systemic sclerosis. Semin Arthritis Rheum 2015; 44: 428-36. https://doi.org/10.1016/j.semarthrit.2014.09.002
- 39. Daoussis D, Liossis SN, Tsamandas AC, Kalogeropoulou C, Kazantzi A, Sirinian C, Kar. Experience with rituximab in scleroderma: results from a 1-year, proof-of-principle study. Rheumatology (Oxford) 2010; 49: 271-280. https://doi.org/10.1093/rheumatology/kep093
- 40. Khan K, Xu S, Nihtyanova S, Derrett-Smith E, Abraham D, Denton CP, et al. Clinical and pathological significance of interleukin 6 overexpression in systemic sclerosis. Ann Rheum Dis 2012; 71: 1235-1242. https://doi. org/10.1136/annrheumdis-2011-200955
- 41. 41. Khanna D, Denton CP, Jahreis A, van Laar JM, Cheng S, Spotswood H, et al. Safety and efficacy of subcutaneous tocilizumab in adults with systemic sclerosis: week 48 data from the faSScinate trial. Ann Rheum Dis 2018; 77: 212-20. https://doi.org/10.1136/annrheumdis- 2017-211682
- 42. Khanna D , Lin CFL, Furst DF, Goldin J, Kim G, Kuwana M, et al.; focuSSced investigators. Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med. 2020; 8(10): 963-74. https://doi.org/10.1016/S2213-2600(20)30318-0
- 43. Gordon JK, Spiera RF. Targeting tyrosine kinases: a novel therapeutic strategy for systemic sclerosis. Curr Opin Rheumatol 2010; 22(6): 690- 5. https://doi.org/10.1097/ BOR.0b013e32833f1105
- 44. Spiera RF, Gordon JK, Mersten JN, Magro CM, Mehta M, WildmanHF, et al. Imatinib mesylate (Gleevec) in the treatment of diffuse cutaneous systemic sclerosis: results of a 1-year, phase IIa, single-arm, open-label clinical trial. Ann Rheum Dis 2011; 70(6): 1003-9. https://doi. org/10.1136/ard.2010.143974
- 45. Bournia VK, Evangelou K, Sfikakis PP. Therapeutic inhibition of tyrosine kinases in systemic sclerosis: a review of published experience on the first 108 patients treated with imatinib. Semin Arthritis Rheum 2013; 42(4): 377-90. https://doi.org/10.1016/j.semarthrit.2012.06.001
- 46. McCormack PL. Nintedanib: first global approval. Drugs 2015; 75: 129-39. https://doi.org/10.1007/s40265-014- 0335-0
- 47. Hilberg F, Roth GJ, Krssak M, Kautschitsch S, Sommergruber W, Tontsch-Grunt U, et al. BIBF 1120: triple angiokinase inhibitor with sustained receptor blockade and good antitumor efficacy. Cancer Res 2008; 68: 4774-82. https:// doi.org/10.1158/0008-5472.CAN-07-6307
- 48. Distler O, Brown KK, Distler JHW, Assassi S, Maher TM, Cottin V, et al. Design of a randomised, placebo-controlled clinical trial of nintedanib in patients with systemic sclerosis- associated interstitial lung disease (SENSCIS™). Clin Exp Rheumatol 2017; (35 Suppl) 106(4): 75-81.
- 49. Highland K, Distler O, Kuwana M, Allanore Y, Assassi S, Azuma A, et al. Efficacy and safety of nintedanib in patients with systemic sclerosis-associated interstitial lung disease treated with mycophenolate: a subgroup analysis of the SENSCIS trial. Lancet Respir Med. 2021; 9(1) :96- 106. https://doi.org/10.1016/S2213-2600(20)30330-1
- 50. Noble PW, Albera C, Bradford WZ, Costabel U, Glassberg MK, Kardatzke D, et al.; CAPACITY Study Group. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet 2011; 377(9779): 1760-9. https://doi.org/10.1016/S0140- 6736(11)60405-4
- 51. Khanna D, Albera C, Fischer A, Khalidi N, Raghu G, Chung L, et al. An Open-label, Phase II Study of the Safety and Tolerability of Pirfenidone in Patients with Sclerodermaassociated Interstitial Lung Disease: the LOTUSS Trial. Journal Rheumatol 2016; 43:9; https://doi.org/10.3899/ jrheum.151322
- 52. Miura Y, Saito T, Fujita K, Tanaka T, Tsunoda Y, Azuma A, et al. Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31(3): 235-8.
- 53. Acharya N, Sharma SK, Mishra D, Dhooria S, Dhir V, Jain S. Efficacy and safety of pirfenidone in systemic sclerosis- related interstitial lung disease-a randomised controlled trial. Rheumatol Int. 2020; 40(5): 703-10. https://doi.org/10.1007/s00296-020-04565-w
- 54. Sullivan KM, Goldmuntz EA, Keyes-Elstein L, McSweeney PA, Pinckney A, Welch, B, et al.; for the SCOT Study Investigators. Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma. N Engl J Med 2018; 378: 35-47. https://doi.org/10.1056/ NEJMoa1703327
- 55. van Laar JM, Farge D, Tyndall A. Autologous Stem cell Transplantation International Scleroderma (ASTIS) trial: hope on the horizon for patients with severe systemic sclerosis. Ann Rheum Dis. 2005; 64(10): 1515. https:// doi.org/10.1136/ard.2005.043240
- 56. Goldin J, Keyes-Elstein L, Crofford L, Furst DE, Goldmuntz E, Mayes MD, et al. Changes in quantitative scleroderma lung ct measures in patients treated with cyclophosphamide or transplantation. Arthritis Rheumatol 2018; 70 (Suppl 10).
- 57. Bernstein EJ, Peterson ER, Sell JL, D’Ovidio F, Arcasoy SM, Bathon JM, et al. Survival of adults with systemic sclerosis following lung transplantation: a nationwide cohort study. Arthritis Rheumatol 2015;67:1314-1322. https://doi. org/10.1002/art.39021
- 58. Khan IY, Singer LG, de Perrot M, Granton JT, Keshavjee S, Chau C, et al. Survival after lung transplantation in systemic sclerosis: a systematic review. Respir Med 2013; 107: 2081-2087. https://doi.org/10.1016/j.rmed.2013.09.015
- 59. Crespo MM, Bermudez CA, Dew MA, Johnson BA, George MP, Bhama J, et al. Lung transplantation in patients with scleroderma compared with pulmonary fibrosis: short and long-term outcomes in a single institution. Ann Am Thorac Soc 2016;13: 784-92. https://doi.org/10.1513/ AnnalsATS.201503-177OC
- 60. Miele CH, Schwab K, Saggar R, Duffy E, Elashoff D, Tseng CH, et al. Lung transplant outcomes in systemic sclerosis with significant esophageal dysfunction: a comprehensive single center experience. Ann Am Thorac Soc 2016; 13: 793-802. https://doi.org/10.1513/AnnalsATS.201512- 806OC