ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Azathioprine Compared to Mycophenolate Mofetil Treatment in Patients with Interstitial Lung Disease Associated with Systemic Sclerosis
Session Title
TP28 - TP028 APPROACH TO THERAPY IN FIBROSING AND NON-FIBROSING ILD
Abstract
A1915 - Azathioprine Compared to Mycophenolate Mofetil Treatment in Patients with Interstitial Lung Disease Associated with Systemic Sclerosis
Author Block: J. Shell1, J. Kapralik2, A. Jones3, M. Farooqi2, K. Beattie4, M. R. Kolb2, G. P. Cox2, C. J. Scallan5, M. J. Larché4, N. A. Khalidi4, N. Hambly5; 1Department of Medicine, McMaster University, Hamilton, ON, Canada, 2Department of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada, 3Department of Health Research Methods, McMaster University, Hamilton, ON, Canada, 4Department of Medicine, Division of Rheumatology, McMaster University, Hamilton, ON, Canada, 5Respirology, McMaster University, Hamilton, ON, Canada.
Rationale: Systemic Sclerosis associated Interstitial Lung Disease (SSc-ILD) is one of the leading causes of mortality in SSc with challenges in both identifying patients at risk and therapeutic decision making due to the variable presentation and course. There is increasing evidence to guide management but there remains a paucity of evidence in the treatment of early disease. One of the cornerstones of therapy is early initiation of disease-modifying medications to reduce the risk of progressive lung deterioration. Many drugs have been studied in patients with SSc-ILD including corticosteroids, mycophenolate mofetil (MMF), azathioprine (AZA) and cyclosporine (CYC). MMF has been increasingly used due to a better side effect profile compared to CYC but has never been directly compared to AZA.
Objective:The aim of this project is to compare outcomes in patients with SSc-ILD treated with MMF and AZA.
Methods: Data from the Canadian Scleroderma Research Group Database was used to identify adult patients with SSc-ILD. Of the 1700 patients identified, 233 had SSc-ILD. Age, sex, time since SSc diagnosis, co-existing pulmonary hypertension, 5 year mortality and 10 year mortality were analysed using chi-square for categorical variables and Wilcoxon rank-sum for continuous variables.
Results: Of the 233 patients with SSc-ILD in the database, 108 were treated with either MMF or AZA. Patients were predominantly female (81%). Age, baseline forced vital capacity (FVC) % predicted, diffusing capacity for carbon monoxide (DLCO) % predicted and co-existing pulmonary hypertension were similar between groups. Patients treated with AZA had treatment started closer to the time of their ILD diagnosis than those treated with MMF (0.87 years vs 1.74 years, p = 0.05).
When comparing those patients treated with MMF and AZA there was no significant difference in mortality at 5 or 10 years post treatment initiation. At 5 years, 9 (14.1%) of patients treated with MMF and 7 (15.9%) treated with AZA had passed away (p =0.79) and at 10 years, it was 17.2% and 29.5% respectively (p = 0.13). Similarly, there was no significant difference in change in pulmonary function over time. At 5 years post treatment initiation, the MMF group’s FVC declined 11.4% compared to 6.4% in those treated with AZA (p = 0.27) and the decline in DLCO was 8.1% and 3.5% respectively (p = 0.85).
Conclusion: Our results suggest in SSc-ILD there is no significant difference in survival or change in lung function when comparing groups treated with MMF or AZA.
Author Block: J. Shell1, J. Kapralik2, A. Jones3, M. Farooqi2, K. Beattie4, M. R. Kolb2, G. P. Cox2, C. J. Scallan5, M. J. Larché4, N. A. Khalidi4, N. Hambly5; 1Department of Medicine, McMaster University, Hamilton, ON, Canada, 2Department of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada, 3Department of Health Research Methods, McMaster University, Hamilton, ON, Canada, 4Department of Medicine, Division of Rheumatology, McMaster University, Hamilton, ON, Canada, 5Respirology, McMaster University, Hamilton, ON, Canada.
Rationale: Systemic Sclerosis associated Interstitial Lung Disease (SSc-ILD) is one of the leading causes of mortality in SSc with challenges in both identifying patients at risk and therapeutic decision making due to the variable presentation and course. There is increasing evidence to guide management but there remains a paucity of evidence in the treatment of early disease. One of the cornerstones of therapy is early initiation of disease-modifying medications to reduce the risk of progressive lung deterioration. Many drugs have been studied in patients with SSc-ILD including corticosteroids, mycophenolate mofetil (MMF), azathioprine (AZA) and cyclosporine (CYC). MMF has been increasingly used due to a better side effect profile compared to CYC but has never been directly compared to AZA.
Objective:The aim of this project is to compare outcomes in patients with SSc-ILD treated with MMF and AZA.
Methods: Data from the Canadian Scleroderma Research Group Database was used to identify adult patients with SSc-ILD. Of the 1700 patients identified, 233 had SSc-ILD. Age, sex, time since SSc diagnosis, co-existing pulmonary hypertension, 5 year mortality and 10 year mortality were analysed using chi-square for categorical variables and Wilcoxon rank-sum for continuous variables.
Results: Of the 233 patients with SSc-ILD in the database, 108 were treated with either MMF or AZA. Patients were predominantly female (81%). Age, baseline forced vital capacity (FVC) % predicted, diffusing capacity for carbon monoxide (DLCO) % predicted and co-existing pulmonary hypertension were similar between groups. Patients treated with AZA had treatment started closer to the time of their ILD diagnosis than those treated with MMF (0.87 years vs 1.74 years, p = 0.05).
When comparing those patients treated with MMF and AZA there was no significant difference in mortality at 5 or 10 years post treatment initiation. At 5 years, 9 (14.1%) of patients treated with MMF and 7 (15.9%) treated with AZA had passed away (p =0.79) and at 10 years, it was 17.2% and 29.5% respectively (p = 0.13). Similarly, there was no significant difference in change in pulmonary function over time. At 5 years post treatment initiation, the MMF group’s FVC declined 11.4% compared to 6.4% in those treated with AZA (p = 0.27) and the decline in DLCO was 8.1% and 3.5% respectively (p = 0.85).
Conclusion: Our results suggest in SSc-ILD there is no significant difference in survival or change in lung function when comparing groups treated with MMF or AZA.
