Document resource
Background Systemic sclerosis (SSc) is a multi-organ autoimmune disease presenting interstitial lung disease (ILD) as the most common internal organ manifestation as it can be found in 25–90% of radiological imaging even without any symptoms. ILD in SSc (ILD-SSc) causes decreased mortality and morbidity, but the effectiveness of mycophenolate immunosuppression treatment reduces ILD progression by 75.5%. The risk of progression is still fairly high during immunosuppression, signifying the need to assess predictor factors for the success of mycophenolate treatment in patients with ILD-SSc.Objective This study aims to investigate the incidence of successful mycophenolate treatment in ILD-SSc and predictor factors for the success based on real-world experience.Methods A retrospective cohort design was applied in this study using outpatient medical record data of patients with extensive ILD-SSc from January 2021 to December 2024. Predictor model was developed from the results of multivariate analysis using linear regression followed by performance and internal validity tests.Results A total of 119 patients with ILD-SSc who met the inclusion criteria were selected as study subjects. The incidence of successful mycophenolate treatment was 68.1%. Predictor factors influencing treatment success in ILD-SSc were obtained from multivariate analysis, such as younger age at onset of ILD-SSc has higher risk ratio for successfull treatment response (RR 2.327; 95% CI 1.510 to 3.586; p<0.001), type limited SSc (RR 0.389; 95% CI 0.251 to 0.602; p<0.001) and extent of ILD at initial diagnosis (RR 2.230; 95% CI 1.356 to 3.670; p=0.002). Predictor score model for mycophenolate treatment success with these three factors had an area under the curve performance of 0.671 (95% CI 0.567 to 0.776; p=0.001) and good calibration based on the Hosmer-Lemeshow test (p=0.576).Conclusion The success rate of mycophenolate treatment in ILD-SSc at Dr. Cipto Mangunkusumo National Hospital (RSUPN) has comparable results with the reports in other countries. Factors such as age at onset of ILD-SSc diagnosis, extent of ILD and type of SSc are independent predictors of mycophenolate treatment success.