Temporal trends in vascular medication use in 8,079 patients with systemic sclerosis: insights to inform future trials and therapeutic strategies from the EUSTAR cohort.

Objectives: Systemic sclerosis (SSc) is characterised 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: 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 nonlinear increases were noted for ERA and CCB whereas nonlinear increase was observed for PDE5i. Year-by-year and nonlinear decrease was observed for Iloprost prescription.

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