Comparison of the effectiveness of cyclophosphamide and rituximab treatment in patients with systemic sclerosis-related interstitial lung diseases: a retrospective, observational cohort study.

ABSTRACT

OBJECTIVES: To compare the effectiveness of cyclophosphamide and rituximab in the treatment of patients with systemic sclerosis with pulmonary involvement (SSc-ILD). METHODS: Symptoms and the respiratory function parameters of 34 patients receiving cyclophosphamide and 27 patients receiving rituximab for at least 24 months between 1996 and 2018 were compared. RESULTS: It was observed that symptoms including cough, Raynaud's phenomenon, digital ulceration, diarrhea, and dysphagia, but not dyspnea, recovered statistically significantly more in the rituximab group (p = 0.004, p = 0.001, p = 0.006, p = 0.005, and p < 0.001, respectively; for dyspnea p = 0.11). When differences in FVC and FVC% values were compared with baseline, it was found that there was a statistically significant increase in FVC (mL) (p = 0.02) and FVC% (p = 0.002) values after 12 months of treatment in patients receiving cyclophosphamide compared with those receiving rituximab. When differences in DLCO and DLCO% values from baseline were compared, a statistically significant increase was seen in DLCO values after 15 and 24 months (p = 0.003 and p = 0.048, respectively) of treatment, also in DLCO% values after 15 and 18 months (p = 0.008 and p = 0.01, respectively) of treatment in patients receiving rituximab compared with those receiving cyclophosphamide. CONCLUSION: It was observed that both cyclophosphamide and rituximab treatments were effective in controlling dyspnea and worsened pulmonary function in SSc-ILD. The effect of cyclophosphamide is more prominent on FVC and rituximab is more effective on DLCO. Key Points • Both cyclophosphamide and rituximab treatments were effective in controlling dyspnea and worsened pulmonary function in SSc-ILD. • The effect of cyclophosphamide is more prominent on FVC and rituximab is more effective on DLCO.