RT Journal Article SR Electronic T1 Observational Study of Treatment Outcome in Early Diffuse Cutaneous Systemic Sclerosis JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 116 OP 124 DO 10.3899/jrheum.090668 VO 37 IS 1 A1 ARIANE L. HERRICK A1 MARK LUNT A1 NINA WHIDBY A1 HOLLY ENNIS A1 ALAN SILMAN A1 NEIL McHUGH A1 CHRISTOPHER P. DENTON YR 2010 UL http://www.jrheum.org/content/37/1/116.abstract AB Objective. Randomized clinical trials in early diffuse cutaneous systemic sclerosis (dcSSc) are challenging. We used an observational approach to estimate the relative effectiveness of different current treatment approaches, capturing entry and outcome data in a standardized way. Methods. Patients with dcSSc within 3 years of the onset of skin thickening were included. Standardized entry and followup data were collected in relation to the first disease-modifying treatment at baseline and 4–6 weeks, then 3, 6, 12, 18, 24, 30, and 36 months. The 5 different protocols were (1) intravenous cyclophosphamide followed by mycophenolate mofetil (MMF); (2) antithymocyte globulin followed by MMF; (3) MMF alone; (4) no disease-modifying treatment; (5) other immunosuppressant treatment. The primary outcome measure was the modified Rodnan skin score (mRSS). Inverse probability of treatment weights were used to allow for differing patient characteristics between groups. Results. The study included 147 patients from 12 centers. Numbers of patients starting on Protocols 1 to 5 were 29, 25, 61, 19, and 13, respectively. mRSS decreased over time from 24 (IQ 19–32) at baseline to 15.5 (IQ 9–24.5) at 3 years. Although there were differences in the magnitude of the change for different protocols, there were no significant differences between protocols in the rate of change of mRSS over time (p = 0.43). When inverse probability weights were applied, the results remained nonsignificant (p = 0.41). Conclusion. Using this observational approach, there were no obvious differences in outcome between groups after allowing as far as possible for baseline differences in treatment allocations.