Predictors of rituximab efficacy in systemic sclerosis-associated interstitial lung disease: machine-learning analysis of the DESIRES trial

美罗华 医学 安慰剂 内科学 间质性肺病 胃肠病学 C反应蛋白 肺活量 随机对照试验 事后 析因分析 免疫学 病理 扩散能力 炎症 肺功能 淋巴瘤 替代医学
作者
Ai Kuzumi,Koji Oba,Satoshi Ebata,Kosuke Kashiwabara,Keiko Ueda,Yukari Uemura,Takeyuki Watadani,Takemichi Fukasawa,Shunsuke Miura,Asako Yoshizaki‐Ogawa,Hidenori Kage,Sato Shin'ichi,Ayumi Yoshizaki
出处
期刊:Rheumatology [Oxford University Press]
标识
DOI:10.1093/rheumatology/keae716
摘要

Abstract Objectives Rituximab is emerging as a promising therapeutic option for systemic sclerosis-associated interstitial lung disease (SSc-ILD). However, little is known about factors that predict the efficacy of rituximab in SSc-ILD. Methods A post-hoc analysis was performed on prospective data from 48 patients with SSc-ILD in the double-blind, randomized, placebo-controlled DESIRES trial. A total of 28 baseline factors were selected as candidates to predict the efficacy of rituximab on the percentage of predicted forced vital capacity (ppFVC) at 24 weeks. A machine learning causal tree algorithm was used to explore the combination of predictors to identify subpopulations with a good response to rituximab. Results Serum levels of C-reactive protein (CRP) and Krebs von den Lungen-6 (KL-6) were selected as branches of the decision tree to stratify patients into 3 subpopulations. In the subpopulation with serum CRP levels ≥ 0.055 mg/dl, ΔppFVC was significantly higher in the rituximab group than in the placebo group (difference 8.01% [95% CI: 4.40%, 11.62%]). In the subpopulation with serum CRP levels < 0.055 mg/dl and serum KL-6 levels ≥ 364 U/ml, ΔppFVC was comparable between the two groups (difference 2.47% [95% CI: -1.99%, 6.92%]). In the subpopulation with serum CRP levels < 0.055 mg/dl and serum KL-6 levels < 364 U/ml, ΔppFVC was significantly lower in rituximab than in placebo (difference -6.85% [95% CI: -10.80%, -2.91%]). Conclusion Even slight elevations in serum CRP levels are associated with the improvement in ppFVC and may serve as predictors of rituximab efficacy in SSc-ILD.

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