AB0678 ANTIPROLIFERATIVE AND VASOACTIVE TREATMENT MODALITIES IN 457 CONSECUTIVE PATIENTS WITH SYSTEMIC SCLEROSIS FROM ACADEMIC CENTERS IN GREECE

Background: The pathophysiology of Systemic Sclerosis (SSc) encompasses autoimmunity, microvascular damage and fibrosis of the skin and internal organs. Accordingly, the two mainstays of treatment comprise antiproliferative and vasoactive regimens. So far there are limited data regarding the actual use of these agents in daily clinical practice. Objectives: To describe current treatment modalities based on standard practice decisions according to published recommendations and/or guidelines for SSc, as well as to determine to which extent different disease modifying agents, namely antiproliferative and vasoactive drugs, are administered to these patients. Methods: Consecutive patients from 7 academic rheumatology departments across Greece who fulfilled the 1980 american College of Rheumatology criteria for classification of SSc and were examined between January 2016 and December 2018 at least once, were included in the study. Patients’ medical records were analyzed and antiproliferative and vasoactive agents administered anytime during the disease course were recorded. Results: A total of 457 patients (87% women, 51% diffuse SSc, 62% with pulmonary fibrosis, 55% with digital ulcers, mean±SD age at diagnosis 49.2±13.1 years, disease duration 10.4±8 years) were studied. Methotrexate was the most frequent antiproliferative agent ever administered (53% of patients, 55% of them with diffuse SSc) followed by cyclophosphamide (26%, 78% of them diffuse), mycophenolate (11%, 63% of them diffuse), azathioprine (10%, 64% of them diffuse), rituximab (9%, 84% of them diffuse) and tocilizumab (3%, 68% of them diffuse). Among vasoactive agents, endothelin receptor antagonists (ERA) were most frequently ever administered in 39% of patients (64% with diffuse SSc) followed by iloprost in 7% (55% diffuse) and 5 phosphodiesterase (5PDE) inhibitors in 5.5% of patients (62% diffuse). Among all antiproliferative/vasoactive agents used, the greatest retention rate at last follow-up visit since initiation had ERA (82%) and 5PDE inhibitors (86%). Of note, 20% of SSc patients (90% women, 70% limited SSc, age at diagnosis 50.4±13.2 years, disease duration 8.4±6.4 years) had never been treated with either antiproliferative or vasoactive agents, whereas 41% had ever received only antiproliferative and 8% only vasoactive therapy. Moreover, 1/5 of patients with pulmonary fibrosis had never received antiproliferative treatment, whereas 1/3 of patients with digital ulcers had never received vasoactive drugs (Table). Conclusion: About 20% of contemporary SSc patients, including patients with pulmonary fibrosis and digital ulcers, have never received antiproliferative or vasoactive therapy, possibly reflecting the spectrum of benign disease and/or a subgroup of under-treated patients. References: Disclosure of interests: None declared