TOPLINE

Rheumatologists responding to an international survey demonstrated wide variation in prescribing immunosuppressive drugs to patients with limited cutaneous systemic sclerosis (SSc), with more than half prescribing these drugs to treat skin symptoms but only 1 in 5 prescribing them to prevent future complications.

METHODOLOGY

• Researchers conducted an international web-based survey from April to June 2025 to assess immunosuppressive drug prescribing practices in limited cutaneous SSc among general rheumatologists and SSc experts.
• They distributed the survey to 756 members of Canadian and Quebec rheumatology associations and 250 SSc experts from the Scleroderma Clinical Trials Consortium and the Canadian Scleroderma Research Group.
• Survey questions focused on prescribing practices for patients with limited cutaneous SSc in the absence of clinically significant arthritis, myocarditis, myositis, or interstitial lung disease requiring immunosuppressive therapy, assuming no drug contraindications; most questions pertained to patients with limited or no skin involvement.
• Overall, 139 participants completed the survey (14% response rate), of whom 94% were rheumatologists.

TAKEAWAY

• Among the respondents, 58% reported at least sometimes using immunosuppressive drugs to treat cutaneous symptoms in patients with limited cutaneous SSc, and 21% reported at least sometimes prescribing these drugs for preventing future complications. Only 12% of the respondents reported prescribing these drugs for prevention in patients without skin involvement.
• Most respondents (73%-86%) would likely treat patients with limited cutaneous SSc who showed signs of active skin disease, including tendon friction rubs and new areas of skin thickening.
• A majority of respondents would likely treat patients with subclinical organ involvement, including signs of myocardial inflammation (92%) or myocardial fibrosis (68%) and subclinical interstitial lung disease with preserved pulmonary function (68%). Mycophenolate mofetil was the first-line drug of choice for preventing future SSc complications.
• Many respondents (80%-92%) would likely consider prescribing a treatment if it could prevent severe digital vasculopathic, skin, cardiopulmonary, gastrointestinal, and myositis manifestations, whereas 62%-68% would consider a treatment if it could prevent gastroesophageal reflux, fatigue, and sicca symptoms.

IN PRACTICE

“This study highlights the knowledge gap and variable treatment practices in [limited cutaneous SSc] treatment with [immunosuppressive] drugs for the indication of skin thickening and prevention of damage accrual,” the authors of the study wrote.

SOURCE

The study was led by Sabrina Hoa, MD, MSc, Centre hospitalier de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada. It was published online on June 1, 2026, as a brief report in Arthritis Care & Research.

LIMITATIONS

The study had a low response rate, and most respondents were from Canada, which may limit the generalizability of the findings. The survey did not explore why prescribing patterns differed across continents.

DISCLOSURES

The study was supported by the Health Data Research Network Canada Pragmatic Trials Training Program team, funded by the Canadian Institutes of Health Research. Two authors reported receiving support from the Fonds de recherche du Québec en Santé, Sclérodermie Québec, and the Université de Montréal Scleroderma Research Chair. One author reported receiving grants, consulting fees, and payment or honoraria from multiple pharmaceutical, biopharmaceutical, and healthcare companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.