Long-term functional course of Sjögren's disease-associated interstitial lung disease.

Background: Interstitial lung disease (ILD) is common in primary Sjögren's disease (pSD); its functional course is poorly known. Our aim was to characterise the long-term functional course and prognosis in patients with pSD-ILD. We determined the role of baseline demographic and clinical variables in the evolution of lung function and identified risk factors for death or transplantation.
Methods: In a retrospective observational cohort study, patients with pSD and ILD were retrospectively identified from two French ILD centres. Forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide ( D _LCO ) slopes were obtained from joint models. Latent class mixed models identified clusters of FVC and D _LCO trajectories.
Results: We included 73 patients (63% women, mean age 63 years), with a median follow-up of 9.3 years. At baseline, mean FVC was 73±21% and D _LCO 51±16%. On average, FVC was stable, while there was an annual decline in D _LCO of 1% of the predicted value. Male sex, a pattern of usual interstitial pneumonia (UIP) or indeterminate for UIP on high-resolution computed tomography (HRCT), and features of fibrosis on HRCT, were associated with an accelerated decline in FVC and D _LCO .
Conclusion: We identified clusters of lung function evolution. 1) Two FVC trajectories: patients with stable FVC (n=56, 78%); patients with FVC decline (n=16, 22%) of 2.4% per year, characterised by a low baseline D _LCO (39%) and a higher risk of death or transplantation (HR 52, 95% CI 10-273). 2) Three D _LCO trajectories: patients with stable D _LCO (n=44, 66%); patients with a slow decline in D _LCO (n=12, 18%) of 2.8% per year; patients with a rapid decline in D _LCO (n=11, 16%) of 4.8% per year, characterised by a low baseline D _LCO (41%) and a higher risk of death or transplantation (HR 156, 95% CI 18-1352).
Competing Interests: Conflict of interest: M-P. Debray declares honoraria for lectures or presentations from Boehringer Ingelheim and Sanofi, and support for attending meetings and/or travel from Boehringer Ingelheim, outside the submitted work. Conflict of interest: R. Borie declares relationships and activities with Boehringer Ingelheim, Ferrer, Sanofi, Chiesi and Roche. Conflict of interest: H. Nunes declares consulting fees, honoraria for lectures or presentations, and support for attending meetings and/or travel from Boehringer Ingelheim outside the submitted work; and reports participation on a data safety monitoring board with Galapagos. Conflict of interest: Y. Uzunhan reports relationships and activities with Boehringer Ingelheim, Pfizer, Sanofi, GlaxoSmithKline and Oxyvie. Conflict of interest: B. Crestani reports relationships and activities with Boehringer Ingelheim, BristolMyersSquibb, Unimed, AstraZeneca, Glycocore, GlaxoSmithKline, Roche, Menarini, CSL Behring, Chiesi, Novartis and Sanofi; and is member of the board of trustees of the Fondation du Souffle, a French charity. Conflict of interest: The remaining authors have no relationships or activities to declare.
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