Intravenous Cyclophosphamide Infusion Effects on Skin Fibrosis, IL-6 and TGF-β1 Responses in Systemic Sclerosis with Interstitial Lung Disease

Rakhma Yanti Hellmi (Department of Internal Medicine, Faculty of Medicine, Diponegoro University)
Harry Isbagio (Division of Rheumatology, Department of Medicine, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia & Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia)
Suharyo Hadisaputro (Doctoral Study Program of Medical and Health Science, Faculty of Medicine, Diponegoro University, Semarang, Indonesia)

Indonesian Journal of Rheumatology
Vol. 18 No. 1 (2026): IJR VOL 18 NO 1

Background: Systemic sclerosis (SSc) is a chronic multisystem disease characterized by organ fibrosis, microvascular damage, and immunological dysregulation. This study aimed to evaluate the effects of intravenous cyclophosphamide (CYC) infusion on skin fibrosis severity, interleukin-6 (IL-6), and transforming growth factor-beta 1 (TGF-β1) levels in patients with SSc-associated interstitial lung disease (SSc-ILD), compared to conventional disease-modifying antirheumatic drug (DMARD) therapy. Methods: This study included patients meeting the 2013 ACR/EULAR classification criteria for SSc. Thirty-two patients (47.8%) received intravenous CYC, while 35 patients (52.2%) received conventional DMARDs. Skin fibrosis severity, assessed by the modified Rodnan skin score (mRSS), alongside serum IL-6 and TGF-β1 levels, were measured at baseline and after six months of therapy. Efficacy was evaluated by comparing post-treatment values to baseline measurements. Results: Both CYC and conventional DMARDs significantly reduced mRSS and serum TGF-β1 levels post-therapy. When comparing the two groups, the reduction in IL-6 levels demonstrated a trend toward statistical significance (p=0.051). Conclusion: Intravenous CYC therapy substantially reduces skin fibrosis (mRSS) and serum TGF-β1 levels in patients with SSc-ILD.