{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T14:27:32Z","timestamp":1793543252721,"version":"4.5.0"},"reference-count":23,"publisher":"The Journal of Rheumatology","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"accepted":{"date-parts":[[2026,8,2]]},"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the effectiveness and safety of rituximab (RTX) plus mycophenolate mofetil (MMF) vs RTX monotherapy in patients with systemic sclerosis\u2013associated interstitial lung disease (SSc-ILD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective comparative analysis among adults with radiologically confirmed SSc-ILD treated with RTX monotherapy or RTX plus MMF (a multitarget approach [MTT]) as an RTX-based treatment strategy. The primary outcome was improvement in percent predicted forced vital capacity (FVC%) &gt; 5 percentage points at the end of the second year (\u0394FVC &gt; +5). Secondary outcomes included longitudinal FVC trajectories over 3 years, skin involvement, and safety. Longitudinal analyses used linear mixed-effects models, with additional sensitivity analyses using inverse probability of treatment weighting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 109 patients (MTT, n = 42; RTX, n = 67), baseline FVC% was lower in the MTT group (50.6 vs 61.0). At the end of 2 years, \u0394FVC &gt; +5 occurred in 69% of patients receiving MTT compared with 33% receiving RTX alone. Over 3 years, the adjusted mean increase in FVC% was greater in the MTT group than in the monotherapy group (+12.9% vs +4.4%), with early separation of lung function trajectories that was sustained throughout follow-up. The association between MTT and greater FVC improvement remained consistent across prespecified subgroups, including patients with severe baseline restriction (FVC% &lt; 45%). Herpes zoster occurred more frequently in the MTT group, whereas serious infections were uncommon in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this real-world study, RTX plus MMF was associated with favorable longitudinal FVC% trajectories compared with RTX monotherapy in a nonrandomized cohort, despite greater baseline disease severity in the MTT group. These findings support prospective evaluation of MTT, particularly in high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3899\/jrheum.2026-0069","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:20:25Z","timestamp":1786796425000},"page":"1243-1252","source":"Crossref","is-referenced-by-count":0,"title":["Multitarget Therapy With Rituximab Plus Mycophenolate Mofetil Versus Rituximab Monotherapy in Systemic Sclerosis\u2013Associated Interstitial Lung Disease"],"prefix":"10.3899","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8670-1745","authenticated-orcid":false,"given":"Rudra P.","family":"Goswami","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9256-4094","authenticated-orcid":false,"given":"Vamshikrishna Patel","family":"Kotha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7354-0708","authenticated-orcid":false,"given":"Manupati","family":"Surya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"2026110105301038000_53.11.1243.1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa550"},{"key":"2026110105301038000_53.11.1243.2","doi-asserted-by":"publisher","DOI":"10.1177\/2397198320915042"},{"key":"2026110105301038000_53.11.1243.3","doi-asserted-by":"crossref","first-page":"2956","DOI":"10.1093\/rheumatology\/keae394","article-title":"The 2024 British Society for Rheumatology guideline for management of systemic sclerosis","volume":"63","author":"Denton","year":"2024","journal-title":"Rheumatology"},{"key":"2026110105301038000_53.11.1243.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-226430"},{"key":"2026110105301038000_53.11.1243.5","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/S2213-2600(16)30152-7","article-title":"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":"2026110105301038000_53.11.1243.6","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key213"},{"key":"2026110105301038000_53.11.1243.7","doi-asserted-by":"crossref","first-page":"103492","DOI":"10.1016\/j.jaut.2025.103492","article-title":"Evaluation of the mycophenolate mofetil\u2013rituximab combination in systemic sclerosis: a French retrospective multicenter study (MycRiSSc)","volume":"157","author":"Barde","year":"2025","journal-title":"J Autoimmun"},{"key":"2026110105301038000_53.11.1243.8","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/s12016-021-08889-8","article-title":"Current concepts on the pathogenesis of systemic sclerosis","volume":"64","author":"Truchetet","year":"2021","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026110105301038000_53.11.1243.9","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.933468"},{"key":"2026110105301038000_53.11.1243.10","doi-asserted-by":"publisher","DOI":"10.1111\/cei.13238"},{"key":"2026110105301038000_53.11.1243.11","doi-asserted-by":"publisher","DOI":"10.1002\/art.38098"},{"key":"2026110105301038000_53.11.1243.12","first-page":"221","article-title":"Prediction equations for spirometry in adults from northern India","volume":"56","author":"Chhabra","year":"2014","journal-title":"Indian J Chest Dis Allied Sci"},{"key":"2026110105301038000_53.11.1243.13","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.semarthrit.2020.08.004","article-title":"Rituximab as a rescue treatment added on mycophenolate mofetil background therapy in progressive systemic sclerosis associated interstitial lung disease unresponsive to conventional immunosuppression","volume":"50","author":"Narv\u00e1ez","year":"2020","journal-title":"Semin Arthritis Rheum"},{"key":"2026110105301038000_53.11.1243.14","first-page":"142","article-title":"Combination therapy with rituximab and mycophenolate mofetil in systemic sclerosis. A single-centre case series study","volume":"36","author":"Fraticelli","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"2026110105301038000_53.11.1243.15","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.200484"},{"key":"2026110105301038000_53.11.1243.16","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02071-2022"},{"key":"2026110105301038000_53.11.1243.17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/acr2.11210","article-title":"Rituximab versus mycophenolate in the treatment of recalcitrant connective tissue disease\u2013associated interstitial lung disease","volume":"3","author":"Zhu","year":"2021","journal-title":"ACR Open Rheumatol"},{"key":"2026110105301038000_53.11.1243.18","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2025-005493"},{"key":"2026110105301038000_53.11.1243.19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ard.2025.05.107","article-title":"OP0085 Outcomes of upfront combination vs monotherapy with rituximab or mycophenolate mofetil for systemic sclerosis interstitial lung disease (SSc-ILD): results from an EUSTAR cohort study [abstract]","volume":"84","author":"Benfaremo","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026110105301038000_53.11.1243.20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa055120"},{"key":"2026110105301038000_53.11.1243.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908681"},{"key":"2026110105301038000_53.11.1243.22","doi-asserted-by":"publisher","DOI":"10.1177\/2397198319889549"},{"key":"2026110105301038000_53.11.1243.23","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/S2213-2600(20)30318-0","article-title":"Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial","volume":"8","author":"Khanna","year":"2020","journal-title":"Lancet Respir Med"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.2026-0069","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T13:30:46Z","timestamp":1793539846000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.2026-0069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,15]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,11,1]]},"published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.3899\/jrheum.2026-0069"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.2026-0069","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,15]]}}}