Low-dose oral imatinib in the treatment of systemic sclerosis interstitial lung disease unresponsive to cyclophosphamide: a phase II pilot study

Paolo Fraticelli, Barbara Gabrielli, Giovanni Pomponio, Gabriele Valentini, Silvia Bosello, Piersandro Riboldi, Maria Gerosa, Paola Faggioli, Roberto Giacomelli, Nicoletta Del Papa, Roberto Gerli, Claudio Lunardi, Stefano Bombardieri, Walter Malorni, Angelo Corvetta, Gianluca Moroncini, Armando Gabrielli, Imatinib in Scleroderma Italian Study Group, Anna Maria Giammarioli, Giovanna Cuomo, Michele Iudici, Elena Bartoloni, Paola Cipriani, Lisa Gabbriellini, Silvia Svegliati, Donatella Amico, Matteo Marcosignori, Martina Bonifazi, Simona Giori, Paolo Fraticelli, Barbara Gabrielli, Giovanni Pomponio, Gabriele Valentini, Silvia Bosello, Piersandro Riboldi, Maria Gerosa, Paola Faggioli, Roberto Giacomelli, Nicoletta Del Papa, Roberto Gerli, Claudio Lunardi, Stefano Bombardieri, Walter Malorni, Angelo Corvetta, Gianluca Moroncini, Armando Gabrielli, Imatinib in Scleroderma Italian Study Group, Anna Maria Giammarioli, Giovanna Cuomo, Michele Iudici, Elena Bartoloni, Paola Cipriani, Lisa Gabbriellini, Silvia Svegliati, Donatella Amico, Matteo Marcosignori, Martina Bonifazi, Simona Giori

Abstract

Introduction: Pulmonary involvement represents a major cause of death of systemic sclerosis (SSc) patients. Recent data suggest that tyrosine kinase inhibitors, such as imatinib, may be a therapeutic option for SSc patients. However, preliminary published clinical trials were inconclusive about imatinib efficacy and showed side effects. The purpose of this study was to verify efficacy and tolerability of low-dose imatinib on interstitial lung disease in a cohort of SSc patients unresponsive to cyclophosphamide therapy.

Methods: Thirty consecutive SSc patients with active pulmonary involvement, unresponsive to cyclophosphamide, were treated with imatinib 200 mg/day for 6 months followed by a 6-month follow-up. A "good response" was defined as an increase of forced vital capacity (FVC) by more of 15% and/or increase of diffusing capacity of carbon monoxide (DLCO) >15% and PaO2 > 90% of initial value and high-resolution computed tomography (HRCT)-scan pattern unchanged or improved.

Results: Twenty-six patients completed the study. Three patients died and one patient was lost to follow-up. Four patients (15.32%) had a good response, 7 worsened and 15 had a stabilized lung disease. Overall, 19 (73.07%) patients had an improved or stabilized lung disease. After a 6-month follow-up, 12 (54.5%) of the 22 patients showed an improved or stabilized lung disease.

Conclusions: Lung function was stabilized in a large proportion of patients unresponsive to cyclophosphamide therapy and a beneficial outcome emerged from the analysis of HRCT lung scans. There was no significant improvement of skin involvement, and the low dose was well tolerated. These data provide useful suggestions to design future randomized clinical trials for SSc therapeutics.

Trial registration: ClinicalTrials.gov NCT00573326. Registered 13 December 2007.

Figures

Figure 1
Figure 1
Trial profile. Six-month data were obtained on all but four patients. At 12-month visit, pulmonary function tests were available in 22 patients. PNX, pneumothorax.
Figure 2
Figure 2
Number of lung segments with high-resolution computed tomography ground-glass opacities and honeycombing in all patients at baseline and at 6 months. Number of lung segments with high-resolution computed tomography ground-glass opacities (A) and honeycombing (B) in all 26 patients at baseline and at 6 months (T6), and in the subgroups of patients classified as improved, stabilized, and worsened after 6 months of treatment with imatinib (C). (A), (B) Data expressed as median with interquartile ranges. (C) Data expressed as absolute numbers of lung segments.

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