Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis.

Autor:	Guédon AF; Institut Pierre Louis d'Epidemiologie et de Sante Publique, Paris, Île-de-France, France alexis.guedon2@aphp.fr.; Sorbonne Université, APHP, Service de Médecine Interne, Hopital Saint-Antoine, Paris, Île-de-France, France., Carrat F; Institut Pierre Louis d'Epidemiologie et de Sante Publique, Paris, Île-de-France, France., Mouthon L; Department of Internal Medicine, Hopital Cochin, Paris, Île-de-France, France., Launay D; Department of Internal Medicine and Clinical immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Univ. Lille, Inserm, CHU de Lille, Lille, Hauts-de-France, France., Chaigne B; Department of Internal Medicine, Hopital Cochin, Paris, Île-de-France, France., Pugnet G; Internal Medicine Department, CHU Toulouse, Toulouse, Occitanie, France., Lega JC; Department of Internal and Vascular Medicine, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France., Hot A; Department of Internal Medicine, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France., Cottin V; National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France., Agard C; Service de Médecine Interne, Centre Hospitalier Universitaire de Nantes, Nantes, France., Allanore Y; Department of Rheumatology, Hospital Cochin, Paris, Île-de-France, France., Fauchais AL; Department of Internal Medicine, CHU Limoges, Limoges, Nouvelle-Aquitaine, France., Lescoat A; Department of Internal Medicine and Clinical Immunology, CHU de Rennes, Rennes, Bretagne, France., Dhote R; Department of Internal Medicine, Hopital Avicenne, Bobigny, France., Papo T; Department of Internal Medicine, Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France., Chatelus E; Rheumatology, Hopitaux universitaires de Strasbourg, Strasbourg, France., Bonnotte B; Department of Internal Medicine, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, Bourgogne-Franche-Comté, France., Kahn JE; Department of Internal Medicine, Hopital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France., Diot E; Department of Internal Medicine and Clinical Immunology, CHRU de Tours, Tours, Centre-Val de Loire, France., Aouba A; Department of Internal Medicine, CHU Caen, Caen, Normandie, France., Magy-Bertrand N; Department of Internal Medicine, Centre Hospitalier Universitaire de Besancon, Besancon, Bourgogne-Franche-Comté, France., Queyrel V; Internal Medicine, CHU Nice, Nice, Provence-Alpes-Côte d'Azu, France., Le Quellec A; Service de Médecine Interne, CHU de Montpellier, Montpellier, Occitanie, France., Kieffer P; Service de médecine interne, GHR Mulhouse Sud Alsace, Mulhouse, Grand Est, France., Amoura Z; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses, Hopital Universitaire Pitie-Salpetriere, Paris, Île-de-France, France., Granel B; Internal Medicine Department, Assistance Publique - Hopitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azu, France., Gaultier JB; Service de Médecine Interne, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, Auvergne-Rhône-Alpes, France., Balquet MH; Department of Internal Medicine, Centre Hospitalier de Lens, Lens, France., Wahl D; Vascular Medicine and Center for autoimmune diseases, Nancy University Hospital Center, Nancy, Grand Est, France., Lidove O; Department of Internal Medicine, Groupe hospitalier Diaconesses Croix Saint-Simon, Paris, Île-de-France, France., Espitia O; Departement of internal and vascular medicine, CHU Nantes, Nantes, Pays de la Loire, France., Cohen A; Service de cardiologie, Hopital Saint-Antoine, Paris, Île-de-France, France., Fain O; Sorbonne Université, APHP, Service de Médecine Interne, Hopital Saint-Antoine, Paris, Île-de-France, France., Hachulla E; Department of Internal Medicine and Clinical immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Univ. Lille, Inserm, CHU de Lille, Lille, Hauts-de-France, France., Mekinian A; Sorbonne Université, APHP, Service de Médecine Interne, Hopital Saint-Antoine, Paris, Île-de-France, France., Rivière S; Sorbonne Université, APHP, Service de Médecine Interne, Hopital Saint-Antoine, Paris, Île-de-France, France.
Jazyk:	angličtina
Zdroj:	RMD open [RMD Open] 2024 Dec 09; Vol. 10 (4). Date of Electronic Publication: 2024 Dec 09.
DOI:	10.1136/rmdopen-2024-004918
Abstrakt:	Background and Aims: Systemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments. Methods: We used data from a national multicentric prospective study using the French SSc national database. We estimated the average treatment effect (ATE) of sildenafil, bosentan, angiotensin-converting enzyme (ACE) inhibitors and iloprost on diastolic dysfunction, altered ejection fraction <50% and pulmonary arterial hypertension (PAH) using a causal method, namely the longitudinal targeted minimum loss-based estimation, to adjust for confounding and informative censoring. Results: We included 1048 patients with available data regarding treatment. Regarding sildenafil analyses, the ATE on diastolic dysfunction at 3 years was -2.83% (95% CI -4.06; -1.60, p<0.00001), and the estimated ATE on altered ejection fraction <50% was -0.88% (95% CI -1.70; -0.05, p=0.037). We did not find a significative effect on PAH. Regarding bosentan, ACE inhibitors and iloprost, none of them neither showed a significant effect on diastolic dysfunction, altered ejection fraction <50% or PAH. Conclusions: Using causal methods, our study is the first and largest suggesting that sildenafil might have benefits among SSc patients regarding diastolic dysfunction and altered ejection fraction occurrence. However, further studies assessing the effect of vasodilators on heart-related outcome among SSc patients are needed to confirm those exploratory results. Competing Interests: Competing interests: AM is the investigator of CELGENE, ROCHE and CHUGAI founded trials with APHP and Hopital 15-20 promotion; AM received several fees for congress travels and experts’ use from LFB, SANOFI, SHIRE and CELGENEEH; speakers bureau, Johnson & Johnson, GlaxoSmithKline, Roche-Chugai, Otsuka; consultant of Bayer, Boehringer Ingelheim, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Novartis; grant/research support from CSL Behring, GlaxoSmithKline, Johnson & Johnson, Roche-Chugai, Sanofi-Genzyme, Sobi, Novartis, ED; and received fees as speaker in symposium from Boehringer Ingelheim. OL received several fees for congress travels and experts’ use from Amicus Therapeutics, Chiesi, Sanofi-Genzyme and Takeda. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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