Recent advances in the treatment of systemic sclerosis

Vasiliki Kalliopi K Bournia, Panayiotis G. Vlachoyiannopoulos, Carlo F Selmi, Haralampos M. Moutsopoulos, M. Eric Gershwin

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Systemic sclerosis (SSc) is a chronic autoimmune disease with clinical manifestations resulting from immune activation, fibrosis development, and damage of small blood vessels. Our aim was to critically illustrate the available data on the new treatments proposed for SSc to provide a clinically oriented overview of the current evidence. PubMed was used for literature search using "scleroderma" and "therapy" to identify all articles published on indexed journals between 1972 and 2008. The search was limited to publications in English and produced a total of 3,441 references, which included 735 review articles. These citations were then screened for articles dealing with the most recent therapy options for SSc, and 214 articles were selected for evaluation and discussion. Methotrexate, cyclophosphamide, calcium channel blockers, angiotensin converting enzyme inhibitors, prostacyclin analogues, d-penicillamine, and extracorporeal photopheresis are the most widely studied treatments for SSc and were considered as practiced treatments. Other therapeutic approaches have been developed more recently and include endothelin receptor antagonists and phosphodiesterase-5 inhibitors for pulmonary arterial hypertension and peripheral vascular disease. High-dose immunosuppression and stem cell transplantation constitute a promising treatment and data from randomized controlled trials are awaited. Intravenous gamma globulins, mycophenolate mophetil, collagen tolerance induction, rituximab, fluoxetine, pirfenidone, relaxin, halofuginone, anti-TGF-β antibodies, and tyrosine kinase inhibitors awaits more solid data. The clinical management of patients with SSc remains a challenge and currently involves practiced and newly proposed therapeutic approaches. The disease pleiomorphism poses numerous difficulties to determine ideal outcomes to be used in clinical trials.

Original languageEnglish (US)
Pages (from-to)176-200
Number of pages25
JournalClinical Reviews in Allergy and Immunology
Volume36
Issue number2-3
DOIs
StatePublished - Jun 2009

Keywords

  • Antifibrotic agents
  • Immunomodulators
  • Scleroderma
  • Stem cell transplant

ASJC Scopus subject areas

  • Immunology and Allergy

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    Bournia, V. K. K., Vlachoyiannopoulos, P. G., Selmi, C. F., Moutsopoulos, H. M., & Gershwin, M. E. (2009). Recent advances in the treatment of systemic sclerosis. Clinical Reviews in Allergy and Immunology, 36(2-3), 176-200. https://doi.org/10.1007/s12016-008-8114-x