Biologic therapy may improve systemic sclerosis but not skin involvement

Anti–tumor necrosis factor α (anti–TNF-α) agents appear to improve inflammatory arthritis and disability in patients with systemic sclerosis (SSc). However, their utility for skin involvement is less certain.

Phumethum and coworkers reviewed the literature for evidence that biologic agents are safe and effective for patients with SSc. They also looked for evidence of specific benefits-improvement in inflammatory arthritis and skin scores and a reduction in disability. Overall, 23 studies selected from 1413 citations were evaluated; 5 studies involved anti–TNF-α agents, including etanercept and infliximab, and the remainder involved other biologics.

The studies with etanercept and infliximab showed improvement in inflammatory arthritis and Health Assessment Questionnaire Disability Index (HAQ-DI) score. There were no reports of opportunistic infection, anaphylaxis, hospitalizations, or death among patients with SSc treated with etanercept in one study. None of the other biologic agents were linked with reproducible, significant improvements in joint count, HAQ-DI score, or skin score.

The authors noted that well-designed, adequately powered clinical trials are needed to further evaluate the efficacy of these agents in SSc and large, longitudinal studies are needed to evaluate their long-term safety.