Research article
High frequency of corticosteroid and immunosuppressive therapy in patients with systemic sclerosis despite limited evidence for efficacy
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* Corresponding author: Nicolas Hunzelmann Nico.Hunzelmann@uni-koeln.de
- † Equal contributors
1 Department of Dermatology and Venerology, University of Cologne, Kerpener Straße 62, Cologne 50924, Germany
2 Hospital of Rheumatology, Burtscheider Markt 24, Aachen 52066, Germany
3 Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, Cologne 50924, Germany
4 Clinical Research Unit for Rheumatology, University Medical Center Freiburg, Hugstetter Straße 49, Freiburg 79106, Germany
5 Department of Dermatology, Dresden University Hospital, Fetscherstraße 74, Dresden 01307, Germany
6 Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Benekestraße 2-8, Bad Nauheim 61231, Germany
7 Rheumatology and Clinical Immunology, Charité, Charitéplatz 1, Berlin 10117, Germany
8 Medical Clinic I, Hospital Cologne-Merheim, Ostmerheimer Straße 200, Cologne 51109, Germany
9 Department of Dermatology, University of Münster, Von-Esmarch-Straße 58, Münster 48149, Germany
Arthritis Research & Therapy 2009, 11:R30 doi:10.1186/ar2634
Published: 4 March 2009Abstract
Introduction
In systemic sclerosis (SSc) little evidence for the effectiveness of anti-inflammatory and immunosuppressive therapy exists. The objective of this study was to determine the extent to which SSc patients are treated with corticosteroids and immunosuppressive agents.
Methods
Data on duration and dosage of corticosteroids and on the type of immunosuppressive agent were analyzed from 1,729 patients who were registered in the German Network for Systemic Scleroderma (DNSS).
Results
A total 41.3% of all registered SSc patients was treated with corticosteroids. Corticosteroid use was reported in 49.1% of patients with diffuse cutaneous SSc and 31.3% of patients with limited cutaneous SSc (P < 0.0001). Among patients with overlap disease characteristics, 63.5% received corticosteroids (P < 0.0001 vs. limited cutaneous SSc). A total 16.1% of the patients received corticosteroids with a daily dose ≥ 15 mg prednisone equivalent. Immunosuppressive therapy was prescribed in 35.8% of patients. Again, among those patients with overlap symptoms, a much higher proportion (64.1%) was treated with immunosuppressive agents, compared with 46.4% of those with diffuse cutaneous SSc sclerosis and 22.2% of those with limited cutaneous SSc (P < 0.0001). The most commonly prescribed drugs were methotrexate (30.5%), cyclophosphamide (22.2%), azathioprine (21.8%) and (hydroxy)chloroquine (7.2%). The use of these compounds varied significantly between medical subspecialties.
Conclusions
Despite limited evidence for the effectiveness of corticosteroids and immunosuppressive agents in SSc, these potentially harmful drugs are frequently prescribed to patients with all forms of SSc. Therefore, this study indicates the need to develop and communicate adequate treatment recommendations.