OBJECTIVES: Therapeutic management of localized scleroderma (LSc) is not standardized and generally unsatisfactory. The objective of this research was to characterize real-world treatment patterns among LSc patients in diverse healthcare delivery settings in the United States.

METHODS: Patients from 6 specialty dermatology networks and 7 integrated delivery networks within the OMNY Health Database with any indication of LSc (ICD-10: L94.0) from 2017-2021 were included. Demographic characteristics were tabulated at first LSc diagnosis. Percentages of patients with prescriptions/procedures for any of the following treatments were computed and tabulated by year: topical corticosteroids (TCS), systemic corticosteroids (SCS), methotrexate, cyclosporine, phototherapy, phenytoin, interferon, and D-penicillamine. Results across the study period were regenerated by disease severity as measured by physician global assessment.

RESULTS: From 2017-2022, a total of 5,466 LSc patients and 13,756 associated encounters were included. Distributions of gender (74% female), race (87% White, 5% Black, 8% Other among known categories), and age (42% > 60 years, 50% 21-60 years, 8% < 21 years) were tabulated. TCS were the most common treatments observed, ranging from 58% to 65% of patients, peaking in 2019. SCS prescriptions remained steadily between 4.2% and 5.9% across calendar years. Methotrexate use changed slightly from 1.5% in 2017 to 3.0% in 2022. Phototherapy was performed minimally, in approximately 1% of the patients across the study period. Prescriptions of most therapies increased monotonically with disease severity (mild/moderate/severe): SCS (3.1%/6.8%/23%), methotrexate (3.5%/6.5%/24%), phototherapy (0.5%/3.6%/13%). Cyclosporine, phenytoin, interferon, and D-penicillamine use were negligible over the study period.

CONCLUSIONS: Results provide insights into real-world therapeutic management of LSc. Trends over time were relatively stable across most therapies. Disease severity was strongly associated with greater prescriptions of almost all therapies. As treatment guidelines evolve, future analyses would be helpful to understand the landscape of LSc therapeutic management.