A RECENT analysis from the RESOLVE-1 trial has highlighted the potential of mycophenolate mofetil (MMF) in treating diffuse cutaneous systemic sclerosis (dcSSc), particularly in early-stage disease. The study compared the efficacy of various immunosuppressive therapies (ISTs) in a well-defined cohort of dcSSc patients, offering valuable insights for clinicians managing this challenging condition.
Skin Improvement: Patients with a disease duration of ≤2 years experienced a mean reduction of 10.8 points in the modified Rodnan skin score (mRSS) when treated with MMF, compared to a 4.8-point reduction in those not receiving IST. Other ISTs yielded intermediate improvements.
Lung Function Preservation: Over a 52-week period, patients on MMF maintained stable forced vital capacity (FVC), whereas those without IST experienced an approximate decline of 160 mL.
Autoantibody Influence: The efficacy of MMF varied based on antinuclear antibody subgroups. Notably, patients positive for anti–topoisomerase 1 autoantibodies showed greater skin and lung benefits with MMF. Conversely, anti–RNA polymerase III autoantibody–positive patients improved rapidly in mRSS regardless of IST use.
These findings robustly support the routine use of MMF in dcSSc, especially for patients with early-stage disease. Moreover, individuals with high-risk antibodies for lung fibrosis might be particularly suitable candidates for MMF treatment. This underscores the importance of personalized therapy in managing dcSSc, tailoring treatment strategies to individual patient profiles.
The RESOLVE-1 trial initially assessed lenabasum in dcSSc patients, permitting background IST at the investigators’ discretion. The lack of significant differences between treatment arms provided a unique opportunity to evaluate the relative efficacy of different ISTs within a large, well-defined patient cohort.
The analysis from the RESOLVE-1 trial emphasizes the potential of MMF as a frontline therapy for dcSSc, particularly in early-stage disease and in patients with specific autoantibody profiles. These insights can guide clinicians in optimizing treatment strategies, improving patient outcomes in this complex and often debilitating condition.
Reference: White B et al. Comparative Efficacy of Immunosuppressive Therapies in the Treatment of Diffuse Cutaneous Systemic Sclerosis. ACR Open Rheumatol. 2025;7:e70004.
Anaya Malik | AMJ
