Temporal trends in vascular medication use in 8079 patients with systemic sclerosis: insights to inform future trials and therapeutic strategies from the EUSTAR cohort

Objectives:
Systemic sclerosis (SSc) is characterized by widespread vascular damage resulting in digital and systemic vasculopathic sequelae. Although there are effective treatments available, vascular disease remains a significant cause of morbidity and mortality in SSc. Our aim was to describe patterns of vascular medication use in SSc, including examination for potential changes over time.

Methods:
A cross-sectional study of SSc patients enrolled in the EUSTAR database meeting 2013 ACR/EULAR SSc criteria. Patients were divided into two time periods: 2012–2017 and 2018–2022. We analysed the prescription patterns of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5i), calcium channel blockers (CCB), intravenous iloprost, and antiplatelet therapies. Logistic regression was used to evaluate temporal trends and interaction effects.

Results:
A total of 8079 patients were included. Significant increases over time were observed in the use of ERA (7% to 12%, P < 0.001), PDE5i (5.4% to 7.2%, P = 0.064), CCB (20% to 32%, P < 0.001) and anti-platelet therapies (15% to 20%, P < 0.001). There was a notable decrease in iloprost use (3.1% to 0.3%, P < 0.001). The prevalence of active digital ulcers (DU) decreased (16% to 13%, P = 0.040), while a history of DU (24% to 30%, P < 0.001) increased. Year-by-year and non-linear increases were noted for ERA and CCB whereas non-linear increase was observed for PDE5i. Year-by-year and non-linear decrease was observed for Iloprost prescription.

Conclusion:
A significant change has occurred over time in vascular medication use in SSc patients, with increased utilization of ERA, PDE5i, CCB and anti-platelet therapies suggesting the adoption of more proactive and/or preventive treatment strategies.