{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:31:35Z","timestamp":1787614295079,"version":"build-2736575974"},"reference-count":59,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Systemic scleroderma (SSc) is an autoimmune disease characterized by excessive collagen production and progressive fibrosis. As the disease advances, vascular injury leads to fibrosis of the skin and internal organs, among which interstitial lung disease (ILD) carries the worst prognosis. Recent advances in biomarkers, imaging techniques, and innovative therapies offer hope for improving outcomes and quality of life in patients with SSc and ILD. To evaluate the usefulness of disease biomarkers and the efficacy and safety of immunomodulatory therapies in SSc-associated ILD (SSc-ILD), a literature review was conducted using the PubMed database for studies published mainly over the last 5 years. After applying inclusion criteria, 53 clinical studies were analyzed. Treating SSc-ILD remains challenging, with therapeutic strategies aiming to suppress inflammation and limit fibrosis progression. Clinical studies have demonstrated moderate to good efficacy of immunosuppressants such as cyclophosphamide (CYC) and mycophenolate mofetil (MMF), showing improvements in lung function parameters, such as forced vital capacity (FVC), and slowing disease progression. Additionally, biological agents such as nintedanib and tocilizumab have shown promising results\u2014nintedanib in reducing the annual rate of FVC decline and tocilizumab in decreasing inflammatory biomarkers and stabilizing pulmonary function. However, despite these therapeutic advances, many studies had small sample sizes, heterogeneous patient populations, and varying inclusion criteria. Given the challenges in diagnostics and the critical need to evaluate the efficacy alongside the safety of immunomodulatory and anti-fibrotic therapies in systemic sclerosis-associated interstitial lung disease (SSc-ILD), there remains a strong demand for large, well-designed, multicenter trials with clearly defined patient cohorts to reliably assess the long-term outcomes of agents such as tocilizumab and nintedanib.<\/jats:p>","DOI":"10.3390\/diagnostics15172243","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T09:18:57Z","timestamp":1756977537000},"page":"2243","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnostics, Efficacy, and Safety of Immunomodulatory and Anti-Fibrotic Treatment for Interstitial Lung Disease Associated with Systemic Scleroderma (SSc-ILD)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8074-0122","authenticated-orcid":false,"given":"Dawid","family":"Piecuch","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Radom, 26-600 Radom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2769-943X","authenticated-orcid":false,"given":"Edyta","family":"Hanczyk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Radom, 26-600 Radom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8336-2094","authenticated-orcid":false,"given":"Katarzyna","family":"Zemsta","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Radom, 26-600 Radom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5093-5337","authenticated-orcid":false,"given":"Micha\u0142","family":"Zwoli\u0144ski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Radom, 26-600 Radom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6647-247X","authenticated-orcid":false,"given":"Szymon","family":"Kopcia\u0142","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Radom, 26-600 Radom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8369-4594","authenticated-orcid":false,"given":"Joanna","family":"Jo\u0144ska","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Health Sciences, University of Radom, 26-600 Radom, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"ref_1","unstructured":"Adigun, R., Goyal, A., and Hariz, A. (2024). Systemic Sclerosis. StatPearls, StatPearls Publishing."},{"key":"ref_2","unstructured":"Odonwodo, A., Badri, T., and Hariz, A. (2024). Scleroderma. StatPearls, StatPearls Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"21912","DOI":"10.1038\/s41598-020-78951-6","article-title":"Serum metabolites as biomarkers in systemic sclerosis-associated interstitial lung disease","volume":"10","author":"Meier","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1002\/art.42133","article-title":"Adipose-Derived Regenerative Cell Transplantation for the Treatment of Hand Dysfunction in Systemic Sclerosis: A Randomized Clinical Trial","volume":"74","author":"Khanna","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s11325-020-02059-4","article-title":"Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma","volume":"25","author":"Yakut","year":"2021","journal-title":"Sleep Breath."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1164\/rccm.202002-0307RR","article-title":"Novel Therapeutic Approaches for Pulmonary Manifestations of Systemic Sclerosis","volume":"202","author":"Lui","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1002\/art.41668","article-title":"Tocilizumab Prevents Progression of Early Systemic Sclerosis-Associated Interstitial Lung Disease","volume":"73","author":"Roofeh","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"109695","DOI":"10.1016\/j.clim.2023.109695","article-title":"Biomarkers of fibrosis, inflammation, and extracellular matrix in the phase 3 trial of tocilizumab in systemic sclerosis","volume":"254","author":"Sheng","year":"2023","journal-title":"Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4397","DOI":"10.1093\/rheumatology\/keac091","article-title":"Dyspnoea and cough in patients with systemic sclerosis-associated interstitial lung disease in the SENSCIS trial","volume":"61","author":"Volkmann","year":"2022","journal-title":"Rheumatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1056\/NEJMoa1903076","article-title":"Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease","volume":"380","author":"Distler","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1136\/annrheumdis-2020-217331","article-title":"Safety and tolerability of nintedanib in patients with systemic sclerosis-associated interstitial lung disease: Data from the SENSCIS trial","volume":"79","author":"Seibold","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e002859","DOI":"10.1136\/rmdopen-2022-002859","article-title":"Effect of nintedanib in patients with systemic sclerosis-associated interstitial lung disease and risk factors for rapid progression","volume":"9","author":"Khanna","year":"2023","journal-title":"RMD Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/art.41965","article-title":"Nintedanib in Patients With Systemic Sclerosis-Associated Interstitial Lung Disease: Subgroup Analyses by Autoantibody Status and Modified Rodnan Skin Thickness Score","volume":"74","author":"Kuwana","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.resinv.2020.10.005","article-title":"Efficacy and safety of nintedanib in Asian patients with systemic sclerosis-associated interstitial lung disease: Subgroup analysis of the SENSCIS trial","volume":"59","author":"Azuma","year":"2021","journal-title":"Respir. Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1093\/rheumatology\/keac535","article-title":"Extent of fibrosis and lung function decline in patients with systemic sclerosis and interstitial lung disease: Data from the SENSCIS trial","volume":"62","author":"Denton","year":"2023","journal-title":"Rheumatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1002\/art.41576","article-title":"Effect of Nintedanib on Lung Function in Patients With Systemic Sclerosis-Associated Interstitial Lung Disease: Further Analyses of a Randomized, Double-Blind, Placebo-Controlled Trial","volume":"73","author":"Maher","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/S2213-2600(20)30330-1","article-title":"Efficacy and safety of nintedanib in patients with systemic sclerosis-associated interstitial lung disease treated with mycophenolate: A subgroup analysis of the SENSCIS trial","volume":"9","author":"Highland","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"SI169","DOI":"10.1093\/rheumatology\/keab886","article-title":"SARS-CoV-2 vaccine in patients with systemic sclerosis: Impact of disease subtype and therapy","volume":"61","author":"Miossi","year":"2022","journal-title":"Rheumatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9468","DOI":"10.1038\/s41598-019-45990-7","article-title":"Performance of a new quantitative computed tomography index for interstitial lung disease assessment in systemic sclerosis","volume":"9","author":"Bocchino","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.3899\/jrheum.180441","article-title":"Cyclophosphamide for Systemic Sclerosis-related Interstitial Lung Disease: A Comparison of Scleroderma Lung Study I and II","volume":"46","author":"Volkmann","year":"2019","journal-title":"J. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1093\/rheumatology\/kez407","article-title":"Association between immunosuppressive therapy and course of mild interstitial lung disease in systemic sclerosis","volume":"59","author":"Hoa","year":"2020","journal-title":"Rheumatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"865","DOI":"10.5114\/ada.2022.120881","article-title":"Arterial hypertension in systemic sclerosis","volume":"39","author":"Wielosz","year":"2022","journal-title":"Postepy Dermatol. Alergol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/art.41153","article-title":"Using Autoantibodies and Cutaneous Subset to Develop Outcome-Based Disease Classification in Systemic Sclerosis","volume":"72","author":"Nihtyanova","year":"2020","journal-title":"Arthritis Rheumatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1093\/rheumatology\/kead234","article-title":"Prognostic and predictive markers of systemic sclerosis-associated interstitial lung disease in a clinical trial and long-term observational cohort","volume":"63","author":"Ghuman","year":"2024","journal-title":"Rheumatology"},{"key":"ref_25","first-page":"161","article-title":"Intravenous versus oral cyclophosphamide for lung and\/or skin fibrosis in systemic sclerosis: An indirect comparison from EUSTAR and randomised controlled trials","volume":"38","author":"Bruni","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1136\/annrheumdis-2019-216823","article-title":"Riociguat in patients with early diffuse cutaneous systemic sclerosis (RISE-SSc): Randomised, double-blind, placebo-controlled multicentre trial","volume":"79","author":"Khanna","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1007\/s10067-023-06623-7","article-title":"Effect of nintedanib in patients with progressive pulmonary fibrosis associated with rheumatoid arthritis: Data from the INBUILD trial","volume":"42","author":"Matteson","year":"2023","journal-title":"Clin. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s12931-022-02095-6","article-title":"Decline in forced vital capacity in subjects with systemic sclerosis-associated interstitial lung disease in the SENSCIS trial compared with healthy reference subjects","volume":"23","author":"Maher","year":"2022","journal-title":"Respir. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/BOR.0000000000000795","article-title":"Treatment for systemic sclerosis-associated interstitial lung disease","volume":"33","author":"Roofeh","year":"2021","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1038\/s41584-019-0184-z","article-title":"Emerging targets of disease-modifying therapy for systemic sclerosis","volume":"15","author":"Volkmann","year":"2019","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s13665-022-00290-w","article-title":"Management of Connective Tissue Disease-related Interstitial Lung Disease","volume":"11","author":"Ahmed","year":"2022","journal-title":"Curr. Pulmonol. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/S2213-2600(19)30480-1","article-title":"Systemic sclerosis-associated interstitial lung disease","volume":"8","author":"Perelas","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2202071","DOI":"10.1183\/13993003.02071-2022","article-title":"Rituximab and mycophenolate mofetil combination in patients with interstitial lung disease (EVER-ILD): A double-blind, randomised, placebo-controlled trial","volume":"61","author":"Mankikian","year":"2023","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1093\/mr\/road068","article-title":"Efficacy and safety of tocilizumab in Japanese patients with systemic sclerosis and associated interstitial lung disease: A subgroup analysis of a global, randomised, controlled Phase 3 trial","volume":"34","author":"Kuwana","year":"2024","journal-title":"Mod. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1136\/annrheumdis-2017-211682","article-title":"Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: Results from the open-label period of a phase II randomised controlled trial (faSScinate)","volume":"77","author":"Khanna","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2645","DOI":"10.1111\/bcp.14676","article-title":"Riociguat: Clinical research and evolving role in therapy","volume":"87","author":"Klinger","year":"2021","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s00109-024-02424-w","article-title":"Emerging therapeutic targets in systemic sclerosis","volume":"102","year":"2024","journal-title":"J. Mol. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1002\/art.42075","article-title":"Nintedanib in Patients with Autoimmune Disease-Related Progressive Fibrosing Interstitial Lung Diseases: Subgroup Analysis of the INBUILD Trial","volume":"74","author":"Matteson","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12931-022-01974-2","article-title":"Safety and tolerability of nintedanib in patients with progressive fibrosing interstitial lung diseases: Data from the randomized controlled INBUILD trial","volume":"23","author":"Cottin","year":"2022","journal-title":"Respir. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12931-021-01668-1","article-title":"Nintedanib and immunomodulatory therapies in progressive fibrosing interstitial lung diseases","volume":"22","author":"Cottin","year":"2021","journal-title":"Respir. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1164\/rccm.201903-0486OC","article-title":"Tracking Impact of Interstitial Lung Disease in Systemic Sclerosis in a Complete Nationwide Cohort","volume":"200","author":"Fretheim","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1093\/rheumatology\/keaa550","article-title":"Rituximab in the treatment of systemic sclerosis-related interstitial lung disease: A systematic review and meta-analysis","volume":"60","author":"Goswami","year":"2021","journal-title":"Rheumatology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S2213-2600(22)00359-9","article-title":"Rituximab versus intravenous cyclophosphamide in patients with connective tissue disease-associated interstitial lung disease in the UK (RECITAL): A double-blind, double-dummy, randomised, controlled, phase 2b trial","volume":"11","author":"Maher","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e546","DOI":"10.1016\/S2665-9913(22)00131-X","article-title":"Safety and efficacy of rituximab in systemic sclerosis (DESIRES): Open-label extension of a double-blind, investigators-initiated, randomised, placebo-controlled trial","volume":"4","author":"Ebata","year":"2022","journal-title":"Lancet Rheumatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1002\/acr.25348","article-title":"2023 American College of Rheumatology (ACR)\/American College of Chest Physicians (CHEST) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases","volume":"76","author":"Johnson","year":"2024","journal-title":"Arthritis Care Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3078","DOI":"10.1002\/art.30467","article-title":"Clinical course of lung physiology in patients with scleroderma and interstitial lung disease: Analysis of the Scleroderma Lung Study Placebo Group","volume":"63","author":"Khanna","year":"2011","journal-title":"Arthritis Rheum."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2797","DOI":"10.1002\/art.30438","article-title":"Predicting treatment outcomes and responder subsets in scleroderma-related interstitial lung disease","volume":"63","author":"Roth","year":"2011","journal-title":"Arthritis Rheum."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s40262-019-00766-0","article-title":"Clinical Pharmacokinetics and Pharmacodynamics of Nintedanib","volume":"58","author":"Wind","year":"2019","journal-title":"Clin. Pharmacokinet."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/14397595.2019.1696505","article-title":"Nintedanib: New indication for systemic sclerosis-associated interstitial lung disease","volume":"30","author":"Kuwana","year":"2020","journal-title":"Mod. Rheumatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1056\/NEJMoa1908681","article-title":"Nintedanib in Progressive Fibrosing Interstitial Lung Diseases","volume":"381","author":"Flaherty","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1177\/2397198319841842","article-title":"Rationale for the evaluation of nintedanib as a treatment for systemic sclerosis-associated interstitial lung disease","volume":"4","author":"Wollin","year":"2019","journal-title":"J. Scleroderma Relat. Disord."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S2213-2600(20)30036-9","article-title":"Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: A randomised, double-blind, placebo-controlled, parallel-group trial","volume":"8","author":"Wells","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1093\/rheumatology\/kead280","article-title":"Effects of nintedanib in patients with limited cutaneous systemic sclerosis and interstitial lung disease","volume":"63","author":"Allanore","year":"2024","journal-title":"Rheumatology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S2213-2600(18)30339-4","article-title":"Long-term safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis: Results from the open-label extension study, INPULSIS-ON","volume":"7","author":"Crestani","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_55","first-page":"CD010908","article-title":"Cyclophosphamide for connective tissue disease-associated interstitial lung disease","volume":"1","author":"Barnes","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/S2213-2600(16)30152-7","article-title":"Sclerodema Lung Study II Investigators. Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): A randomised controlled, double-blind, parallel group trial","volume":"4","author":"Tashkin","year":"2016","journal-title":"Lancet Respir. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1002\/art.42860","article-title":"2023 American College of Rheumatology (ACR)\/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases","volume":"76","author":"Johnson","year":"2024","journal-title":"Arthritis Rheumatol."},{"key":"ref_58","unstructured":"Khanna, D., Spino, C., Bernstein, E., Goldin, J., Tashkin, D., Roth, M., and On Behalf of SLS III Investigators (2022). Combination Therapy of Mycophenolate Mofetil and Pirfenidone vs. Mycophenolate Alone: Results from the Scleroderma Lung Study III [abstract]. Arthritis Rheumatol., 74, Available online: https:\/\/acrabstracts.org\/abstract\/combination-therapy-of-mycophenolate-mofetil-and-pirfenidone-vs-mycophenolate-alone-results-from-the-scleroderma-lung-study-iii\/."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1164\/rccm.202306-1113ST","article-title":"Treatment of systemic sclerosis\u2013associated interstitial lung disease: Evidence-based recommendations. An official American Thoracic Society clinical practice guideline","volume":"209","author":"Raghu","year":"2024","journal-title":"Am. J. Respir. Crit. Care Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2243\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:39:15Z","timestamp":1760035155000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":59,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15172243"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15172243","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]}}}