{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T02:15:36Z","timestamp":1783736136630,"version":"3.55.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum D\u00fcsseldorf. Anstalt \u00f6ffentlichen Rechts"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Therapeutic management of systemic sclerosis (SSc) has evolved considerably in recent years. However, contemporary treatment patterns and prescribing determinants remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the German Network for SSc (DNSS) cohort containing 6,583 patients were analyzed to describe trends in vasoactive, immunomodulatory, and antifibrotic therapy; assess variation between centers and specialties; delineate co-prescription patterns; and identify clinical predictors of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Use of endothelin receptor antagonists and prostanoids \/ prostacyclin receptor agonists increased from 3.0% [95% confidence interval (CI): 1.5%\u20135.3%] in 2005 to 28.4% [25.5%\u201331.3%] in 2025, whereas prescription of calcium channel blockers and phosphodiesterase-5 inhibitors remained stable. Immunomodulatory therapy shifted away from cyclophosphamide towards mycophenolate mofetil, rituximab, and nintedanib, accompanied by a marked decline in glucocorticoid use (50.0% [31.9%\u201368.1%] in 2000 to 18.1% [11.8%\u201325.9%] in 2025). University or rheumatology centers prescribed immunomodulators and antifibrotics more frequently than non-university or dermatology centers. Co-prescription patterns showed common combination therapy with tocilizumab or rituximab and methotrexate. Nintedanib was commonly co-administered with mycophenolate, but also with cyclophosphamide or methotrexate. Rituximab was most commonly combined with mycophenolate and tocilizumab with methotrexate. Multivariable mixed models identified modified Rodnan skin score, interstitial lung disease, heart involvement, and care in a university, particularly rheumatology, center as major determinants of immunomodulatory and antifibrotic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SSc treatment has evolved over the past 25 years, with prescribing patterns increasingly reflecting evidence and guideline recommendations. However, differences between specialties and care settings highlight the need for broader implementation of multidisciplinary, guideline-based care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13075-026-03854-2","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T10:35:39Z","timestamp":1783679739000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world treatment patterns and determinants of therapy in systemic sclerosis: findings from the German Network for SSc 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M. reports lecture fees received from Boehringer Ingelheim Pharma GmbH & Co., Janssen Cilag GmbH, ECM GmbH, AEMH e.V, Leo Pharma GmbH and adboard fees received from Almirall Hermal GmbH, Boehringer Ingelheim Pharma GmbH & Co.","order":12,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"JHWD has received grants or holds contracts from: AbbVie, Anamar, Argenx, ARXX, BMS, Bayer Pharma, Boehringer Ingelheim, Cantargia, Celgene, CSL Behring, ExoTherapeutics, Galapagos, GSK, Inventiva, Kiniksa, Lassen, Novartis, Sanofi-Aventis, RedX and UCB; consulting fees from: AbbVie, Active Biotech, Anamar, ARXX, AstraZeneca, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, Genentech, GSK, Inventiva, Janssen, Novartis, Pfizer, Roche and UCB; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from: AbbVie, Active Biotech, Anamar, ARXX, AstraZeneca, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, Genentech, GSK, Inventiva, Janssen, Novartis, Pfizer, Roche and UCB; Payment for expert testimony from: AbbVie, Anamar, ARXX, AstraZeneca, Bayer Pharma, Boehringer Ingelheim, Cantargia, Celgene, Galapagos, Genentech, GSK, Inventiva, Janssen, Novartis, Pfizer, Roche and UCB; Support for attending meetings and\/or travel from: AbbVie, SOBI; Stock or stock options from: 4D Science; FibroCure; Receipt of equipment, materials, drugs, medical writing, gifts or other services from: Boehringer Ingelheim.","order":13,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"AHG has received honoraria for presentations from Boehringer Ingelheim and AbbVie.","order":14,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The other authors did not declare any conflict of interest.","order":15,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"140"}}