title: High frequency of corticosteroid and immunosuppressive therapy in patients with systemic sclerosis despite limited evidence for efficacy.
abstract: BACKGROUND
  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 >or= 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.
authors.affiliation: Department of Dermatology and Venerology, University of Cologne, Cologne, Germany. Nico.Hunzelmann@uni-koeln.de
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hunzelmann
authors.forename: Pia
authors.initials: P
authors.lastname: Moinzadeh
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Genth
authors.forename: Thomas
authors.initials: T
authors.lastname: Krieg
authors.forename: Walter
authors.initials: W
authors.lastname: Lehmacher
authors.forename: Inga
authors.initials: I
authors.lastname: Melchers
authors.forename: Michael
authors.initials: M
authors.lastname: Meurer
authors.forename: Ulf
authors.initials: U
authors.lastname: Müller-Ladner
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Olski
authors.forename: Christiane
authors.initials: C
authors.lastname: Pfeiffer
authors.forename: Gabriela
authors.initials: G
authors.lastname: Riemekasten
authors.forename: Eckhard
authors.initials: E
authors.lastname: Schulze-Lohoff
authors.forename: Cord
authors.initials: C
authors.lastname: Sunderkoetter
authors.forename: Manfred
authors.initials: M
authors.lastname: Weber
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D012042:Registries; D012595:Scleroderma, Systemic / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents