ATS Clinical Practice Guideline Addresses SSc-ILD Treatment

The Association of Pulmonary Advanced Practice Providers (APAPP) is excited to highlight the American Thoracic Society’s evidence-based clinical practice guideline for the treatment of patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD), as published in the American Journal of Respiratory and Critical Care Medicine. More from Pulmonology Advisor: 

The guideline strongly recommends treating patients with SSc-ILD with mycophenolate and conditionally recommends treatment with cyclophosphamide, nintedanib, rituximab, tocilizumab, and the combination of nintedanib plus mycophenolate.

Notably, the recommendations do not provide a hierarchy of which treatment to use. “[T]he committee felt that a prescriptive decision tree would not be appropriate for this patient population with the evidence that was available,” said the guideline authors. They therefore assessed the medications independently. They also encouraged clinicians to use their recommendations “in conjunction with shared decision-making with patients,” incorporating patient preferences and concerns with respect to side effects, route of administration, and/or cost.

“This guideline aims to serve as a starting point to highlight gaps in evidence to encourage future research into topics and comparisons that can then provide more prescriptive guidance,” stated the guideline authors, an international committee that included pulmonologists with ILD expertise, rheumatologists with SSc expertise, a general pulmonologist, a pulmonologist/rheumatologist with expertise in SSc and ILD, an information scientist, and 2 patients with SSc-ILD.  

The current recommendations are intended for a heterogenous population of patients with SSc-ILD, regardless of their disease status, said guideline authors. From the outset, the authors aimed to provide guidelines based on disease status for 3 patient subgroups: patients initially manifesting of SSc-ILD; patients with stable SSc-ILD; and patients with progressive SSc-ILD. Ultimately, this was not done because information on treatments effects according to disease status was not available.

Find key clinical questions addressed on the full article HERE. 

The Association of Pulmonary Advanced Practice Providers (APAPP) works to advance the profession of APPs in Pulmonary Medicine. We actively seek out opportunites from trusted organizations like ATS to help educate our members on news in our field. 


This post was published by The APAPP staff on behalf of the author(s) – listed above.