Investigational drugs for the treatment of scleroderma: what’s new?

ABSTRACT Introduction Systemic sclerosis (SSc) is an orphan, chronic, autoimmune, fibrotic disease with unknown etiology characterized by progressive fibrosis of the skin and internal organs. SSc has the highest mortality, the deadliest among the connective tissue diseases, despite the introduction of new treatment options in the past decades. Areas covered The aim of the current systematic review was to investigate new targeted therapy and their impact on disease progression, mainly focusing on phase I and II clinical trials within the past three years. Expert opinion Despite recent groundbreaking advancements in understanding SSc pathophysiology, early diagnosis and early introduction of effective targeted treatments within the optimal window of opportunity to prevent irreversible disease damage still represents a significant clinical challenge. Ongoing significant research for new molecular and epigenetics pathways is of fundamental importance to offer new perspectives on disease phenotype and for the development of personalized treatment strategies.

[1]  C. Feghali-Bostwick,et al.  The Molecular Mechanisms of Systemic Sclerosis-Associated Lung Fibrosis , 2023, International journal of molecular sciences.

[2]  J. D. de Vries-Bouwstra,et al.  Sex influence on outcomes of patients with systemic sclerosis-associated interstitial lung disease: an EUSTAR database analysis. , 2022, Rheumatology.

[3]  Hequan Yao,et al.  Targeting the LPA1 signaling pathway for fibrosis therapy: a patent review (2010-present) , 2022, Expert opinion on therapeutic patents.

[4]  M. Humbert,et al.  2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension , 2022, European Respiratory Journal.

[5]  Shinichi Sato,et al.  New Era in Systemic Sclerosis Treatment: Recently Approved Therapeutics , 2022, Journal of clinical medicine.

[6]  P. Kotyla,et al.  Jak Inhibitors for Treatment of Autoimmune Diseases: Lessons from Systemic Sclerosis and Systemic Lupus Erythematosus , 2022, Pharmaceuticals.

[7]  A. Murray,et al.  A phase 2 trial investigating the effects of the angiotensin II type 2 receptor agonist C21 in systemic sclerosis-related Raynaud’s , 2022, Rheumatology.

[8]  E. Garrafa,et al.  Systemic Sclerosis-Specific Antibodies: Novel and Classical Biomarkers , 2022, Clinical Reviews in Allergy & Immunology.

[9]  N. Okiyama,et al.  Safety and efficacy of rituximab in systemic sclerosis (DESIRES): open-label extension of a double-blind, investigators-initiated, randomised, placebo-controlled trial. , 2022, The Lancet. Rheumatology.

[10]  A. Yoshizaki,et al.  POS0857 PHARMACOKINETICS, SAFETY, AND EFFICACY OF SUBCUTANEOUS BRODALUMAB FOR SYSTEMIC SCLEROSIS WITH MODERATE-TO-SEVERE SKIN THICKENING: A SINGLE-ARM, OPEN-LABEL, MULTI-DOSE, PHASE 1 TRIAL , 2022, Annals of the Rheumatic Diseases.

[11]  F. del Galdo,et al.  Dersimelagon, a novel oral melanocortin 1 receptor agonist, demonstrates disease-modifying effects in preclinical models of systemic sclerosis , 2022, Arthritis Research & Therapy.

[12]  A. Yoshizaki,et al.  POS0881 EFFICACY AND SAFETY OF SUBCUTANEOUS BRODALUMAB, A FULLY HUMAN ANTI–IL-17RA MONOCLONAL ANTIBODY, FOR SYSTEMIC SCLEROSIS WITH MODERATE-TO-SEVERE SKIN THICKENING: A MULTICENTER, RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND PHASE 3 STUDY , 2022, Annals of the Rheumatic Diseases.

[13]  J. Reid,et al.  Biological and clinical insights from a randomized phase 2 study of an anti-oncostatin M monoclonal antibody in systemic sclerosis , 2022, Rheumatology.

[14]  Lan Wei,et al.  The Yin and Yang of IL-17 in Systemic Sclerosis , 2022, Frontiers in Immunology.

[15]  S. Svegliati,et al.  PDGF/PDGFR: A Possible Molecular Target in Scleroderma Fibrosis , 2022, International journal of molecular sciences.

[16]  T. Krieg,et al.  Pathophysiology of systemic sclerosis (scleroderma) , 2022, The Kaohsiung journal of medical sciences.

[17]  M. Kreuter,et al.  Dyspnoea and cough in patients with systemic sclerosis–associated interstitial lung disease in the SENSCIS trial , 2022, Rheumatology.

[18]  K. Mawatari,et al.  Interleukin-31 promotes fibrosis and T helper 2 polarization in systemic sclerosis , 2021, Nature Communications.

[19]  W. Schroder,et al.  ROCK2 inhibition attenuates profibrogenic immune cell function to reverse thioacetamide-induced liver fibrosis , 2021, JHEP Reports.

[20]  C. Chizzolini,et al.  Current Concepts on the Pathogenesis of Systemic Sclerosis , 2021, Clinical Reviews in Allergy & Immunology.

[21]  Hannah A. Blair Belumosudil: First Approval , 2021, Drugs.

[22]  M. Baron,et al.  A randomised, double-blind, placebo-controlled phase 3 study of lenabasum in diffuse cutaneous systemic sclerosis: RESOLVE-1 design and rationale. , 2021, Clinical and experimental rheumatology.

[23]  M. Manetti,et al.  New Insights into Profibrotic Myofibroblast Formation in Systemic Sclerosis: When the Vascular Wall Becomes the Enemy , 2021, Life.

[24]  L. Summa,et al.  OP0242 EFFECTS OF THE AUTOTAXIN INHIBITOR ZIRITAXESTAT ON SKIN AND LUNG FIBROSIS IN A MURINE GRAFT-VERSUS-HOST DISEASE MODEL OF SYSTEMIC SCLEROSIS , 2021 .

[25]  D. Furst,et al.  OP0171 PHASE 3 TRIAL OF LENABASUM, A CB2 AGONIST, FOR THE TREATMENT OF DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC) , 2021 .

[26]  C. Campochiaro,et al.  An update on targeted therapies in systemic sclerosis based on a systematic review from the last 3 years , 2021, Arthritis Research & Therapy.

[27]  N. Okiyama,et al.  Safety and efficacy of rituximab in systemic sclerosis (DESIRES): a double-blind, investigator-initiated, randomised, placebo-controlled trial. , 2021, The Lancet. Rheumatology.

[28]  F. Yan,et al.  Safety and efficacy of rituximab in connective tissue disease-associated interstitial lung disease: A systematic review and meta-analysis. , 2021, International immunopharmacology.

[29]  J. Goldin,et al.  Tocilizumab Prevents Progression of Early Systemic Sclerosis–Associated Interstitial Lung Disease , 2021, Arthritis & rheumatology.

[30]  F. Lima,et al.  Role of lysophosphatidic acid and its receptors in health and disease: novel therapeutic strategies , 2021, Signal Transduction and Targeted Therapy.

[31]  G. Raghu,et al.  Efficacy and safety of nintedanib in patients with systemic sclerosis-associated interstitial lung disease treated with mycophenolate: a subgroup analysis of the SENSCIS trial. , 2021, The Lancet. Respiratory medicine.

[32]  Yali Li,et al.  The IL-23/IL-17 Pathway in Inflammatory Skin Diseases: From Bench to Bedside , 2020, Frontiers in Immunology.

[33]  G. Raghu,et al.  Effect of Nintedanib on Lung Function in Patients With Systemic Sclerosis−Associated Interstitial Lung Disease: Further Analyses of a Randomized, Double‐Blind, Placebo‐Controlled Trial , 2020, Arthritis & rheumatology.

[34]  C. Denton,et al.  A randomised, double-blind, placebo-controlled, 24-week, phase II, proof-of-concept study of romilkimab (SAR156597) in early diffuse cutaneous systemic sclerosis , 2020, Annals of the Rheumatic Diseases.

[35]  M. Croft,et al.  TL1A Promotes Lung Tissue Fibrosis and Airway Remodeling , 2020, The Journal of Immunology.

[36]  V. Steen,et al.  Racial Disparities in Systemic Sclerosis. , 2020, Rheumatic diseases clinics of North America.

[37]  D. Isenberg,et al.  Biologic therapies for systemic lupus erythematosus: where are we now? , 2020, Current opinion in rheumatology.

[38]  J. Goldin,et al.  Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial. , 2020, The Lancet. Respiratory medicine.

[39]  B. Léger,et al.  Translational engagement of lysophosphatidic acid receptor 1 in skin fibrosis: from dermal fibroblasts of patients with scleroderma to tight skin 1 mouse , 2020, British journal of pharmacology.

[40]  M. Ralli,et al.  Pathophysiology and therapy of systemic vasculitides , 2020, EXCLI journal.

[41]  T. Horiuchi,et al.  Generation of a novel CD30+ B cell subset producing GM-CSF and its possible link to the pathogenesis of systemic sclerosis. , 2020, Clinical and experimental immunology.

[42]  C. Denton,et al.  Interleukin-31 promotes pathogenic mechanisms underlying skin and lung fibrosis in scleroderma. , 2020, Rheumatology.

[43]  M. Pereira,et al.  Increased levels of the soluble oncostatin M receptor (sOSMR) and glycoprotein 130 (sgp130) in systemic sclerosis patients and associations with clinical parameters. , 2020, Immunobiology.

[44]  Tammara A. Wood,et al.  Safety and Efficacy of Lenabasum in a Phase II, Randomized, Placebo‐Controlled Trial in Adults With Systemic Sclerosis , 2020, Arthritis & rheumatology.

[45]  Sindhu R. Johnson,et al.  Riociguat in patients with early diffuse cutaneous systemic sclerosis (RISE-SSc): randomised, double-blind, placebo-controlled multicentre trial , 2020, Annals of the Rheumatic Diseases.

[46]  A. Gottlieb,et al.  Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial , 2020, The Lancet.

[47]  C. Denton,et al.  Gender-related differences in systemic sclerosis. , 2020, Autoimmunity reviews.

[48]  A. Modarressi,et al.  IL-17A dissociates inflammation from fibrogenesis in systemic sclerosis (scleroderma). , 2020, The Journal of investigative dermatology.

[49]  W. Romanowski,et al.  Factors associated with quality of life in systemic sclerosis: a cross-sectional study , 2019, Quality of Life Research.

[50]  S. Bhattacharyya,et al.  The JAK/STAT pathway is activated in systemic sclerosis and is effectively targeted by tofacitinib , 2019, Journal of scleroderma and related disorders.

[51]  G. Raghu,et al.  Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease. , 2019, The New England journal of medicine.

[52]  V. Strand,et al.  Health-related quality of life in systemic sclerosis compared with other rheumatic diseases: a cross-sectional study , 2019, Arthritis Research & Therapy.

[53]  T. Rodríguez-Reyna,et al.  Systemic Sclerosis Pathogenesis and Emerging Therapies, beyond the Fibroblast , 2019, BioMed research international.

[54]  D. Tweardy,et al.  Role of STAT3 in skin fibrosis and transforming growth factor beta signalling , 2018, Rheumatology.

[55]  M. Currie,et al.  Pharmacological Characterization of IW-1973, a Novel Soluble Guanylate Cyclase Stimulator with Extensive Tissue Distribution, Antihypertensive, Anti-Inflammatory, and Antifibrotic Effects in Preclinical Models of Disease , 2018, The Journal of Pharmacology and Experimental Therapeutics.

[56]  S. Targan,et al.  TL1A blocking ameliorates intestinal fibrosis in the T cell transfer model of chronic colitis in mice. , 2017, Pathology, research and practice.

[57]  M. Boubaya,et al.  Mapping and predicting mortality from systemic sclerosis , 2017, Annals of the rheumatic diseases.

[58]  R. Mueller,et al.  Treatment with Biologicals in Rheumatoid Arthritis: An Overview , 2017, Rheumatology and Therapy.

[59]  G. Schett,et al.  JAK1-dependent transphosphorylation of JAK2 limits the antifibrotic effects of selective JAK2 inhibitors on long-term treatment , 2017, Annals of the rheumatic diseases.

[60]  Qiongxiu Zhou,et al.  Elevated levels of TL1A are associated with disease activity in patients with systemic sclerosis , 2017, Clinical Rheumatology.

[61]  Wenfang Xu,et al.  JAK/STAT Signal Transduction: Promising Attractive Targets for Immune, Inflammatory and Hematopoietic Diseases. , 2016, Current drug targets.

[62]  R. Lafyatis,et al.  An Autotaxin/Lysophosphatidic Acid/Interleukin‐6 Amplification Loop Drives Scleroderma Fibrosis , 2016, Arthritis & rheumatology.

[63]  K. Patra,et al.  Safety and tolerability of an anti-CD19 monoclonal antibody, MEDI-551, in subjects with systemic sclerosis: a phase I, randomized, placebo-controlled, escalating single-dose study , 2016, Arthritis Research & Therapy.

[64]  A. Yoshizaki B lymphocytes in systemic sclerosis: Abnormalities and therapeutic targets , 2016, The Journal of dermatology.

[65]  G. Schett,et al.  Type 2 innate lymphoid cell counts are increased in patients with systemic sclerosis and correlate with the extent of fibrosis , 2015, Annals of the rheumatic diseases.

[66]  M. Whitfield,et al.  Fresolimumab treatment decreases biomarkers and improves clinical symptoms in systemic sclerosis patients. , 2015, The Journal of clinical investigation.

[67]  A. Postlethwaite,et al.  Pathogenesis of Systemic Sclerosis , 2015, Front. Immunol..

[68]  D. Furst,et al.  Update of EULAR recommendations for the treatment of systemic sclerosis , 2015, Annals of the rheumatic diseases.

[69]  Alexander Pautsch,et al.  Mode of action of nintedanib in the treatment of idiopathic pulmonary fibrosis , 2015, European Respiratory Journal.

[70]  J. Liao,et al.  The Rho Kinases: Critical Mediators of Multiple Profibrotic Processes and Rational Targets for New Therapies for Pulmonary Fibrosis , 2015, Pharmacological Reviews.

[71]  J. Weiss,et al.  Selective oral ROCK2 inhibitor down-regulates IL-21 and IL-17 secretion in human T cells via STAT3-dependent mechanism , 2014, Proceedings of the National Academy of Sciences.

[72]  X. Corbella,et al.  Mortality and survival in systemic sclerosis: systematic review and meta-analysis. , 2014, Seminars in arthritis and rheumatism.

[73]  J. V. van Laar,et al.  Interleukin-6 (IL-6) Trans Signaling Drives a STAT3-dependent Pathway That Leads to Hyperactive Transforming Growth Factor-β (TGF-β) Signaling Promoting SMAD3 Activation and Fibrosis via Gremlin Protein , 2014, The Journal of Biological Chemistry.

[74]  G. Schett,et al.  Combined inhibition of morphogen pathways demonstrates additive antifibrotic effects and improved tolerability , 2014, Annals of the rheumatic diseases.

[75]  P. Song,et al.  Pathogenesis pathways of idiopathic pulmonary fibrosis in bleomycin-induced lung injury model in mice , 2014, Respiratory Physiology & Neurobiology.

[76]  Qi Zhou,et al.  CD19 and CD20 Targeted Vectors Induce Minimal Activation of Resting B Lymphocytes , 2013, PloS one.

[77]  J. Pope,et al.  Interleukin 6 in Systemic Sclerosis and Potential Implications for Targeted Therapy , 2012, The Journal of Rheumatology.

[78]  Spencer J. Williams,et al.  FT011, a new anti‐fibrotic drug, attenuates fibrosis and chronic heart failure in experimental diabetic cardiomyopathy , 2012, European journal of heart failure.

[79]  P. Fuschiotti Role of IL-13 in systemic sclerosis. , 2011, Cytokine.

[80]  Herren Wu,et al.  A glycoengineered anti‐CD19 antibody with potent antibody‐dependent cellular cytotoxicity activity in vitro and lymphoma growth inhibition in vivo , 2011, British journal of haematology.

[81]  Marie-Elise Truchetet,et al.  Increased frequency of circulating Th22 in addition to Th17 and Th2 lymphocytes in systemic sclerosis: association with interstitial lung disease , 2011, Arthritis research & therapy.

[82]  R. Gamelli,et al.  Lung 26S and 20S proteasomes are increased in patients with end-stage idiopathic pulmonary fibrosis , 2011 .

[83]  G. de Luca,et al.  B cells in systemic sclerosis: a possible target for therapy. , 2011, Autoimmunity reviews.

[84]  S. Parapuram,et al.  mPGES-1 null mice are resistant to bleomycin-induced skin fibrosis , 2011, Arthritis research & therapy.

[85]  D. Lorrain,et al.  A novel, orally active LPA1 receptor antagonist inhibits lung fibrosis in the mouse bleomycin model , 2010, British journal of pharmacology.

[86]  R. Hays,et al.  Reliability and validity of the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument. , 2009, Arthritis and rheumatism.

[87]  R. Steele,et al.  Quality of Life in Patients with Systemic Sclerosis Compared to the General Population and Patients with Other Chronic Conditions , 2009, The Journal of Rheumatology.

[88]  F. Grimminger,et al.  Soluble guanylate cyclase stimulation: an emerging option in pulmonary hypertension therapy , 2009, European Respiratory Review.

[89]  M. Fujimoto,et al.  Increased Serum Soluble OX40 in Patients with Systemic Sclerosis , 2008, The Journal of Rheumatology.

[90]  T. Luger,et al.  Alpha-melanocyte-stimulating hormone and related tripeptides: biochemistry, antiinflammatory and protective effects in vitro and in vivo, and future perspectives for the treatment of immune-mediated inflammatory diseases. , 2008, Endocrine reviews.

[91]  U. Müller-Ladner,et al.  Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR Scleroderma Trials And Research group database , 2007, Annals of the rheumatic diseases.

[92]  S. Getting,et al.  Targeting melanocortin receptors as potential novel therapeutics. , 2006, Pharmacology & therapeutics.

[93]  C. Schentag,et al.  Quality of life and functional status in systemic sclerosis compared to other rheumatic diseases. , 2006, The Journal of rheumatology.

[94]  P. Kloetzel,et al.  Circulating proteasomes are markers of cell damage and immunologic activity in autoimmune diseases. , 2002, Journal of Rheumatology.

[95]  J. Barrett,et al.  Association of markers for TGFβ3, TGFβ2 and TIMP1 with systemic sclerosis , 2000 .

[96]  T. Medsger,et al.  Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. , 1988, The Journal of rheumatology.

[97]  Colunga Argüelles,et al.  INHIBITION OF MICROSOMAL PROSTAGLANDIN E SYNTHASE-1 (MPGES-1) BY GS-248 REDUCES PROSTAGLANDIN E2 BIOSYNTHESIS WHILE INCREASING PROSTACYCLIN IN HUMAN SUBJECTS , 2020 .

[98]  A. Parodi,et al.  Interleukin-4 and interleukin-13 as possible therapeutic targets in systemic sclerosis. , 2019, Cytokine.

[99]  M. Fujimoto,et al.  Increased serum interleukin 23 in patients with systemic sclerosis. , 2008, The Journal of rheumatology.

[100]  S. L.,et al.  SYSTEMIC SCLEROSIS , 2007 .

[101]  T. Matsushita,et al.  Elevated serum BAFF levels in patients with systemic sclerosis: enhanced BAFF signaling in systemic sclerosis B lymphocytes. , 2006, Arthritis and rheumatism.