Anti-Acid Therapy Not Recommended in Systemic Sclerosis Interstitial Lung Disease

Anti-acid therapy use should be discouraged in patients with systemic sclerosis interstitial lung disease (SSc-ILD), according to study results presented at the European League Against Rheumatism (EULAR) 2020 E-Congress, held online from June 3 to 6, 2020.

Gastroesophageal reflux and treatment with anti-acid therapy are common in patients with SSc. However, the outcomes of anti-acid therapy on SSc development and progression have not been extensively studied. Therefore, researchers prospectively analyzed data from the German Network for Systemic Scleroderma (DNSS) for patients who developed SSc-ILD. Patients without progression to ILD at initial diagnosis were classified as either anti-acid therapy users or nonusers, and their disease outcomes were assessed.

Of the 4131 patients, 1165 (28.2%) had SSc-ILD and 712 had no disease progression at first diagnosis of ILD. A total of 567 patients received anti-acid therapy and 145 did not. There were significant differences between anti-acid therapy users and nonusers in terms of sex (men, 18% vs 25%; P =.05), SSc subtype (diffuse more common in anti-acid therapy users; P =.002), lung function (forced vital capacity, 86% vs 77%; P =.001 and diffuse capacity for carbon monoxide, 66% vs 58%;  P =.001), mRSS (8 vs 11.5; P <.01), esophageal involvement (32% vs 56%; P <.01), and steroid use (30% vs 43%; P =.005).

Although mortality did not differ between anti-acid therapy users and nonusers, progression of disease was more common among patients who received anti-acid therapy (24.5% vs 13%, respectively; P =.03). In addition, there were significant differences in the decline of forced vital capacity ≥10% between anti-acid therapy users and nonusers (30% vs 14%, respectively; P =.017) and a decline in diffuse capacity for carbon monoxide ≥15% was more common by trend in patients who received anti-acid therapy (23% vs 14%, respectively; P =.087).

Study limitations included potential bias because of certain baseline characteristics. Nevertheless, the researchers concluded that their analysis “disfavors” the use of anti-acid therapy in SSc-ILD.

Reference

Kreuter M, Bonella F, Riemekasten G, et al. Does anti-acid treatment influence disease progression in systemic sclerosis interstitial lung disease (SSC-ILD)? Data from the German SSC-Network. Presented at: EULAR 2020 E-Congress; June 3-6, 2020. Abstract AB0584.