Review Article

Systemic Sclerosis Pathogenesis and Emerging Therapies, beyond the Fibroblast

Table 2

Overview of the main clinical trials that evaluate treatments against the inflammatory, fibrotic, and vascular components of SSc.

Drug nameTargetMechanism of actionTrial ID/reference

Treatments against immune mediators

Anifrolumab
(MEDI546)
Directed against subunit 1 of type I interferon receptorDownregulation of T-cell activationNCT00930683

Inebilizumab (MEDI551)Anti-CD19Depletion of B cells through enhanced antibody-dependent cellular cytotoxicityNCT00946699

Sifalimumab
Rontalizumab
Anti-IFNαSpecific for IFNα blocking; doesn’t neutralize other type I IFNsNCT01283139
NCT00541749

MEDI7734Anti-ILT7Temporary depletion of plasmacytoid dendritic cellsNCT02780674

RituximabAnti-CD20Targets CD20 expressed from pre-B cell stage to the pre-plasma cell stageGiuggioli D et al. [10]

BasiliximabAnti-IL-2RαDirected against the α chain (CD25) of the IL-2 receptorBecker MO et al. [11]

EfalizumabLFA1/ICAM-1Interaction between LFA-1 and ICAM-1 is blocked, preventing T-cell’s activationZimmerman T et al. [12]

AbataceptCTLA4Inhibits T-cell activation by selectively modulating costimulation (binds to CD80 or CD86 on cell surface)Elhai M et al. [13]

AIMSPRO (®)αMSH, IL10, CCL2Modulates serum levels of relevant cytokinesQuillinan NP et al. [14]

TocilizumabIL-6RRegulatory effect in the balance between Th17 and TregsNCT01532869

AM095 and SAR100842LPA1Targets specific G-protein-coupled receptorsNCT01651143

TAK242TLR4Prevents Th1 and Th17 cytokines production by inhibiting TLR4 stimulationBhattacharyya S et al. [15]

Treatments against Fibrosis

ImatinibPDGF, TGF-βBlocks both PDGF and TGF-β signalling pathwaysIwamoto N et al. [16]

Dasatinib,
Nilotinib
c-Abl, PDGFSecond-generation TKIs with higher affinity to Bcr-AblAkhmetshina A et al. [17]

Metelimumab (CAT-192)TGFβ1Specifically counteracts the TGFβ1 isoformDenton CP et al. [18]

Fresolimumab (GC-1008)TGFβ1,-β2,-β3Targets all isoforms of TGFβNCT01284322

FG-3019CCN2Anti-CTGF, reduces the number of CD45-positive cellsBrenner MC et al. [19]

P144TGFβ1Blocks the interaction between TGFβ1 and TGFβ1 type III receptorNCT00574613,
Postlethwaite AE et al. [20]

Anti-Integrin V6 (Abituzumab)TGFβInhibits binding to αv heterodimers, preventing TGF-β activationNCT02745145,
Katsumoto et al. [17],
Henderson NC et al. [21]

PirfenidoneTNFα, IL1β, TGFβBlocks TGF-β-stimulated collagen synthesisUdwadia ZF et al. [22]
Khanna D et al. [23]

Nintedanib
(BIBF 1120)
VEGF, PDGF, FGFTKI-targeting FGF, PDGF, and VEGF receptors, as well as Src-family tyrosine kinasesNCT02597933,
Distler et al. [24]

Treatments against vascular alterations

Bosentan,
Macitentan
ETA/ETB receptorBlocks both ETA and ETB endothelin receptors that mediate the effects of ET-1NCT00077584,
Matucci-Cerinic M et al. [25]
NCT00660179,
Metha S et al. [26]

AmbrisentanETA receptorBlocks the action of endothelin-1 at the ETA receptorNCT00091598,
NCT01178073,
Gailè N et al. [27],
Raghu G et al. [28]

SelexipagIP receptorSelective IP prostacyclin receptor agonist for long-term treatment of PAHSitbon O et al. [29],
Denton CP et al. [30]

RiociguatGMPc agonistSoluble guanylate cyclase (sGC) modulator with both vasoactive and antifibrotic effectsNCT02283762,
NCT00863681

Bardoxolone methylNrf2 and NF-κBActivation of Nrf2 and inhibition of NF-κBNCT02036970,
NCT02657356