Oral Glucocorticoids Does Not Add Benefit to Early Systemic Sclerosis Treatment: Study

A new study found no significant benefit in adding low-dose oral glucocorticoids to immunosuppressive therapy for improving skin fibrosis in patients with early diffuse cutaneous systemic sclerosis (dcSSc). The findings of this study were published in the Arthritis Care & Research journal.

This study by Denis Mongina and team wanted to determine whether combining oral glucocorticoids with immunosuppressive therapy could yield better outcomes for patients with early dcSSc. The primary focus was on changes in the modified Rodnan Skin Score (mRSS), a standard measure for assessing skin fibrosis. This research tracked changes from baseline to approximately 12 months by comparing results between two groups: those treated with both glucocorticoids (≤20 mg/day prednisone equivalent) and immunosuppressive therapy, and those receiving only immunosuppressive therapy.

A total of 208 patients were included in the trial, with 104 in each group after matching for comparable baseline characteristics. The patient pool had a mean age of 49 years, with 33% male and 59% testing positive for anti-Scl70 antibodies. In the glucocorticoid-treated group, the patients received a median dose of 5 mg/day of prednisone.

The results showed no meaningful difference in the skin fibrosis outcomes between the two groups. After 12 months, the mRSS decreased by 2.7 points (95% confidence interval [CI] 1.4–4.0) in the treated group when compared to a decrease of 3.1 points (95% CI 1.9–4.4) in the control group. The difference was statistically insignificant (P = 0.64). This pattern remained consistent even among patients with shorter disease durations (≤ 24 months) or those with milder skin involvement (mRSS ≤22).

Also, there was no difference in the secondary outcomes, which included the progression of skin or lung fibrosis and the occurrence of scleroderma renal crisis which is a severe complication of systemic sclerosis. One case of renal crisis was reported in each group, further supporting the conclusion that low-dose glucocorticoid treatment did not increase associated risks.

Overall, the outcomes of this study highlighted that while glucocorticoids are often part of treatment regimens for other inflammatory conditions, their role in early dcSSc remains unsubstantiated at low doses. These findings emphasize the need for careful assessment before incorporating glucocorticoids into treatment protocols for systemic sclerosis patients.

Source:

Mongin, D., Matucci-Cerinic, M., Walker, U. A., Distler, O., Becvar, R., Siegert, E., Ananyeva, L. P., Smith, V., Alegre-Sancho, J. J., Yavuz, S., Limonta, M., Riemekasten, G., Rezus, E., Vonk, M., Truchetet, M.-E., Del Galdo, F., Courvoisier, D. S., Iudici, M., & the EUSTAR Collaborators. (2025). Oral glucocorticoids for skin fibrosis in early diffuse systemic sclerosis: A target trial emulation study from the European Scleroderma Trials and Research Group database. Arthritis Care & Research. https://doi.org/10.1002/acr.25469