{
  "abstract": "Introduction European Alliance of Associations for Rheumatology (EULAR) published 2024 guidelines for systemic sclerosis (SSc) treatment, which newly recommended mycophenolate mofetil (MMF), rituximab (RTX), and tocilizumab (TCZ) as options for skin disease. The purpose of this study is to evaluate present-day treatment of diffuse cutaneous (dc)SSc skin by specialists, including referral patterns for clinical trials.Material and Methods European Alliance of Associations for Rheumatology (EULAR) published 2024 guidelines for systemic sclerosis (SSc) treatment, which newly recommended mycophenolate mofetil (MMF), rituximab (RTX), and tocilizumab (TCZ) as options for skin disease. The purpose of this study is to evaluate present-day treatment of diffuse cutaneous (dc)SSc skin by specialists, including referral patterns for clinical trials.Results 101 physicians responded (90 completed): 43% from North America, 30% from Europe, 15% from South America, 80% practice at an SSc center, and 94% have participated in or referred to SSc trials.MMF was preferred first-line in 91% of respondents for dcSSc with ILD and 70% for dcSSc without ILD. 97% determine therapeutic effectiveness within 6 months. For active skin involvement despite MMF, trial referral was preferred as next step in 60% for patients without ILD and 54% for those with ILD. For skin involvement without ILD, 84% have prescribed RTX; 67% have prescribed TCZ. Of those using TCZ for skin, 63% only do so if inflammatory arthritis is present. In the past 2–3 years, increased RTX and TCZ use was reported in 55% and 38%, respectively. MMF use increased in 41% and remained stable in 58%. Conversely, 47% decreased methotrexate use (figure 1).73% agreed that biologics have impacted trial enrollment. For patients who failed MMF, 32% prefer to prescribe RTX than refer to a trial for those without ILD (32% neutral), and 44% prefer to prescribe RTX than refer to a trial for those with ILD (19% neutral).Regarding placebo-controlled trials without background therapy, 18% were willing to enroll patients with early, active dcSSc in 12-month trials; in 6-month trials, 13% would enroll with ILD and 25% without ILD. However, if the protocol had a clear escape strategy, 67% would enroll patients with dcSSc in a placebo-controlled trial without background therapy. Although 84% were comfortable with uniform background MMF, 81% preferred background therapy to be at their discretion.Conclusions MMF is preferred first-line for diffuse skin involvement for patients with and without ILD. Biologic use has recently increased and impacted trial enrollment. Including escape protocols in dcSSc clinical trials may improve recruitment.Abstract P.282 Figure 1Reported prescribing trends for diffuse cutaneous systemic sclerosis skin involvement, 2022-2025",
  "authors": [
    {
      "affiliations": [
        "Hospital for Special Surgery, Department of Medicine, New York, USA"
      ],
      "name": "Kimberly Lakin"
    },
    {
      "affiliations": [
        "Hospital for Special Surgery, Department of Medicine, New York, USA"
      ],
      "name": "Robert Spiera"
    },
    {
      "affiliations": [
        "Pontificia Universidad Católica de Chile, Department of Medicine, Santiago, Chile",
        "UC CHRISTUS Healthcare System, Santiago, Chile"
      ],
      "name": "Antonia Valenzuela"
    },
    {
      "affiliations": [
        "Hospital for Special Surgery, Department of Medicine, New York, USA"
      ],
      "name": "Deanna Jannat-Khah"
    },
    {
      "affiliations": [
        "Hospital for Special Surgery, Department of Medicine, New York, USA"
      ],
      "name": "Kelsey Gripp"
    },
    {
      "affiliations": [
        "Hospital for Special Surgery, Department of Medicine, New York, USA"
      ],
      "name": "Oshmita Golam"
    },
    {
      "affiliations": [
        "North Bristol NHS Trust, Department of Medicine, Bristol, UK"
      ],
      "name": "John Pauling"
    },
    {
      "affiliations": [
        "Hospital for Special Surgery, Department of Medicine, New York, USA"
      ],
      "name": "Jessica Gordon"
    }
  ],
  "title": "P.282 Impact of updated treatment paradigms on clinical trial referral in diffuse cutaneous systemic sclerosis",
  "uid": "8e9a8dfc-5e02-50a9-8d76-1c5df61208c9"
}