Disease-modifying treatment

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Treatments which modify the progression of systemic sclerosis may be classified into three groups:

• specific immunosuppressant therapy:
  • cyclosporin A:
    • good for skin but bad for kidneys
  • antithymocyte globulin:
    • good for skin
  • plasmapheresis:
    • anecdotal evidence only
• global immunosuppressant therapy:
  • methotrexate
  • corticosteroids
  • alkylating agents e.g. azathioprine, cyclophosphamide
  • ritixumab
    • study suggest that rituximab treatment may provide long-term benefit for patients with systemic sclerosis, and serum immunoglobulins should be explored as potential response markers (1)
      
      
• anti-fibrotic therapy:
  • D-penicillamine:
    • good for lung, skin and kidney
  • interferons alpha & gamma:
  • probably beneficial, but morbidity with interferons is significant

Reference:

• Kuzumi A, Ebata S, Fukasawa T, et al. Long-term Outcomes After Rituximab Treatment for Patients With Systemic Sclerosis: Follow-up of the DESIRES Trial With a Focus on Serum Immunoglobulin Levels. JAMA Dermatol. Published online February 15, 2023. doi:10.1001/jamadermatol.2022.6340