{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:26:18Z","timestamp":1792531578293,"version":"4.5.0"},"reference-count":20,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1176538"],"award-info":[{"award-number":["GNT1176538"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2013842"],"award-info":[{"award-number":["GNT2013842"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010443","name":"RACP Foundation","doi-asserted-by":"publisher","award":["Australian Rheumatology Association & D.E.V. Starr"],"award-info":[{"award-number":["Australian Rheumatology Association & D.E.V. Starr"]}],"id":[{"id":"10.13039\/501100010443","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001782","name":"University of Melbourne","doi-asserted-by":"publisher","award":["John Hayden Research Fellowship"],"award-info":[{"award-number":["John Hayden Research Fellowship"]}],"id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001782","name":"University of Melbourne","doi-asserted-by":"publisher","award":["Paul Desmond Clinical Research Fellowship"],"award-info":[{"award-number":["Paul Desmond Clinical Research Fellowship"]}],"id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To assess the frequency and determinants of immunosuppressant medication use in systemic sclerosis and changes in prescribing patterns over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      The Australian Scleroderma Cohort Study participants meeting the American College of Rheumatology\/European Alliance of Associations for Rheumatology criteria for systemic sclerosis with recorded treatment data were included. The Chi-square, two-sample\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -tests or Wilcoxon rank-sum tests were used for between-group comparison as appropriate. Multivariable logistic regression models were used to establish the determinants of the use of immunosuppressants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 2019 participants, 60% received immunosuppressants, including 81% of those with diffuse systemic sclerosis and 52% of those with limited systemic sclerosis (p\u2009&lt;\u20090.001). Forty-six percent of patients received prednisolone and 40% disease-modifying anti-rheumatic drugs. Immunosuppressant use was more common in those with severe or inflammatory systemic sclerosis features, including interstitial lung disease, synovitis or myositis. Comparing prescribing patterns early in incident systemic sclerosis from 2007\u20132014 to 2015\u20132024, disease-modifying anti-rheumatic drug use increased (35% vs 56%, p\u2009&lt;\u20090.001), while prednisolone use decreased (24% vs 17%, p\u2009=\u20090.046). Immunosuppressants were commenced earlier in incident systemic sclerosis in 2015\u20132024 versus 2007\u20132014 (1.8 (interquartile range = 1.0\u20133.2) vs 2.4 (interquartile range = 1.2\u20134.0) years, p\u2009=\u20090.011). In multivariable modelling, prednisolone use was associated with diffuse systemic sclerosis (odds ratio = 1.8, 95% confidence interval = 1.4\u20132.2, p\u2009&lt;\u20090.001), interstitial lung disease (odds ratio = 2.1, 95% confidence interval = 1.7\u20132.5, p\u2009&lt;\u20090.001), myositis (odds ratio = 2.7, 95% confidence interval = 1.8\u20134.0, p\u2009&lt;\u20090.001), synovitis (odds ratio = 2.2, 95% confidence interval = 1.8\u20132.6, p\u2009&lt;\u20090.001) and systemic sclerosis heart involvement (odds ratio = 1.4, 95% confidence interval = 1.0\u20132.0, p\u2009=\u20090.044). Disease-modifying anti-rheumatic drug exposure was associated with diffuse systemic sclerosis (odds ratio = 2.7, 95% confidence interval = 2.1\u20133.4, p\u2009&lt;\u20090.001), interstitial lung disease (odds ratio = 2.2, 95% confidence interval = 1.7\u20132.7, p\u2009&lt;\u20090.001), myositis (odds ratio = 3.6, 95% confidence interval = 2.4\u20135.5, p\u2009&lt;\u20090.001) and synovitis (odds ratio = 4.2, 95% confidence interval = 3.5\u20135.2, p\u2009&lt;\u20090.001) and inversely associated with age (odds ratio = 0.7, 95% confidence interval = 0.5\u20130.8, p\u2009&lt;\u20090.01) and pulmonary arterial hypertension (odds ratio = 0.5, 95% confidence interval = 0.4\u20130.7, p\u2009&lt;\u20090.001). In subgroups with diffuse systemic sclerosis and limited systemic sclerosis and different autoantibody profiles, findings were generally similar, with interstitial lung disease, synovitis and myositis tending to be associated with prednisolone and\/or disease-modifying anti-rheumatic drug use, as was systemic sclerosis heart involvement in diffuse systemic sclerosis (p\u2009=\u20090.038).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Immunosuppressant use is common in systemic sclerosis, with broadly similar determinants of usage among subtypes and autoantibody status. These real-world data suggest that disease-modifying anti-rheumatic drug use has increased, with earlier implementation of treatment, and a reduction in use of glucocorticoids.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23971983251342690","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:39:27Z","timestamp":1747960767000},"page":"311-321","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Frequency and determinants of use of immunosuppressants in the Australian Scleroderma Cohort Study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4140-2711","authenticated-orcid":false,"given":"Jessica L","family":"Fairley","sequence":"first","affiliation":[{"name":"The University of Melbourne, Melbourne, VIC, Australia"},{"name":"Department of Rheumatology, St. Vincent\u2019s Hospital Melbourne, Fitzroy, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, St. Vincent\u2019s Hospital Melbourne, Fitzroy, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Proudman","sequence":"additional","affiliation":[{"name":"The University of Adelaide, Adelaide, SA, Australia"},{"name":"Royal Adelaide Hospital, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Sahhar","sequence":"additional","affiliation":[{"name":"Monash Health, Melbourne, VIC, Australia"},{"name":"Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene-Siew","family":"Ngian","sequence":"additional","affiliation":[{"name":"Monash Health, Melbourne, VIC, Australia"},{"name":"Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Apostolopoulos","sequence":"additional","affiliation":[{"name":"Monash Health, Melbourne, VIC, Australia"},{"name":"Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Walker","sequence":"additional","affiliation":[{"name":"Royal Adelaide Hospital, Adelaide, SA, Australia"},{"name":"Flinders University, Bedford Park, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren V","family":"Host","sequence":"additional","affiliation":[{"name":"Fiona Stanley Hospital, Perth, WA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Stevens","sequence":"additional","affiliation":[{"name":"The University of Melbourne, Melbourne, VIC, Australia"},{"name":"Department of Rheumatology, St. Vincent\u2019s Hospital Melbourne, Fitzroy, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ross","sequence":"additional","affiliation":[{"name":"The University of Melbourne, Melbourne, VIC, Australia"},{"name":"Department of Rheumatology, St. Vincent\u2019s Hospital Melbourne, Fitzroy, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandana","family":"Nikpour","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Sydney, Sydney, NSW, Australia"},{"name":"Royal Prince Alfred Hospital, Sydney, NSW, Australia"},{"name":"SydneyMSK Research Flagship Centre, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/ar2634"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/23971983211000971"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203317739129"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(16)30152-7"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-022-08945-x"},{"issue":"4","key":"e_1_3_2_7_2","article-title":"Scleroderma renal crisis, an increasingly rare but persistently challenging condition: a retrospective cohort study","volume":"8","author":"Shah RC","year":"2024","unstructured":"Shah RC, Morrisroe K, Stevens W, et al. Scleroderma renal crisis, an increasingly rare but persistently challenging condition: a retrospective cohort study. Rheumatol Adv Pract 2024; 8(4): rkae131.","journal-title":"Rheumatol Adv Pract"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-226430"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204424"},{"issue":"2","key":"e_1_3_2_10_2","first-page":"202","article-title":"Scleroderma (systemic sclerosis): classification, subsets and pathogenesis","volume":"15","author":"LeRoy EC","year":"1988","unstructured":"LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988; 15(2): 202\u2013205.","journal-title":"J Rheumatol"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01913-2018"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.032"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.40560"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2016.10.002"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209909"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2019.102403"},{"key":"e_1_3_2_17_2","first-page":"157","article-title":"Glucocorticoids in systemic sclerosis: weighing the benefits and risks\u2013a systematic review","volume":"31","author":"Iudici M","year":"2013","unstructured":"Iudici M, van der Goes MC, Valentini G, et al. Glucocorticoids in systemic sclerosis: weighing the benefits and risks\u2013a systematic review. Clin Exp Rheumatol 2013; 31(2, Suppl. 76): 157\u2013165.","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac533"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-021-02548-1"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-010-1493-4"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.42861"}],"container-title":["Journal of Scleroderma and Related Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23971983251342690","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23971983251342690","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23971983251342690","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:53:05Z","timestamp":1777981985000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23971983251342690"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/23971983251342690"],"URL":"https:\/\/doi.org\/10.1177\/23971983251342690","relation":{},"ISSN":["2397-1983","2397-1991"],"issn-type":[{"value":"2397-1983","type":"print"},{"value":"2397-1991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}