AB0731 Treatment algorithms for systemic sclerosis according to experts. (12th June 2018)

• Record Type: Journal Article
• Authors: Fernández-Codina, A.; Walker, K.M.; Pope, J.E.
• Is Part Of: Annals of the rheumatic diseases. Volume 77(2018)Supplement 2
• Page Start: 1504
• Page End: 1505
• Publication Date: 2018-06-12
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2018-eular.2862
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Treatment for many aspects of systemic sclerosis (SSc) lacks agreement. Objectives: To generate SSc treatment algorithms endorsed by high percentage of SSc experts. Methods: Experts from the Scleroderma Clinical Trials Consortium and the Canadian Scleroderma Research group (n=170) were asked whether they agreed with SSc algorithms (from 2012 1 ). A further 2 consensus rounds refined agreement; 62 (36%), 54 and 48 experts completed surveys. Results: For scleroderma renal crisis (SRC), 82% of the experts agreed (1st line ACEi, 2nd and 3rd adding: CCB or ARB). Pulmonary arterial hypertension (PAH) had 81% agreement. For mild PAH, PDE5i, then endothelin receptor antagonists plus PDE5i, then prostanoids; while for severe PAH prostanoids were first-line. Raynauds' phenomenon (RP) had 78% of agreement [mild (1st CCB, 2nd adding PDE5i, 3rd ARB or switching to another CCB, 4th prostanoids), severe (1st CCB, 2nd adding PDE5i, 3rd ERA, 4th prostanoids)]. Digital ulcer (DU) treatment had 69% agreement (1st CCB, 2nd PDE5i). Interstitial lung disease (ILD) had 65% agreement including induction (Mycophenolate mofetil (MMF) then intravenous cyclophosphamide then rituximab) and maintenance (1st line MMF). Skin involvement had 71% agreement. For a modified Rodnan skin score (mRSS) of 24 1st MTX, 2nd MMF; and for mRSS 32 1st MMF, 2nd MTX, 3rd intravenous cyclophosphamide (CYP), 4th hematopoietic stem cell transplantation. For inflammatory arthritis 79% agreed with 1st MTX, 2nd low dose glucocorticoids, 3rd hydroxychloroquine, 4th rituximab or tocilizumab. Cardiac and gastrointestinal algorithms had ≥75% agreement. The evolution of the agreement rates is shown in table 1: Agreement is the% who agreed to the algorithm. SSc: Systemic Sclerosis; NA: Not applicable; †For modified Rodnan skin scores 10, 24 and 32, respectively Conclusions: Total agreement for SSc algorithms was considerable. These SSc algorithms may guide treatment. Reference: [1] Walker KM, Pope J. Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts. Semin Arthritis Rheum2012;42:42–55. Disclosure of Interest: A. Fernández-Codina Grant/research support from: Spanish Federation for Internal Medicine; Ontario Scleroderma Association, K. Walker: None declared, J. Pope Grant/research support from: AbbVie, Actelion, Amgen, BMS, GSK, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Consultant for: AbbVie, Actelion, Amgen, BMS, GSK, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB