Efficacy of Raynaud's phenomenon and digital ulcer pharmacological treatment in systemic sclerosis patients: a systematic literature review

Data de publicació: 01/09/2015

Autors de IIS La Fe

José Andrés Román Ivorra

Autor

Autors aliens a IIS La Fe

Lefebvre, PGD
Nishishinya, MB
Pereda, CA
Loza, E
Giraldo, WAS
Carreira, P
Rua-Figueroa, I
Pego-Reigosa, JM
Munoz-Fernandez, S

Grups d'Investigació

Reumatología

Leader

José Andrés Román Ivorra

Abstract

To evaluate the efficacy of current treatments for the Raynaud phenomenon (RP) in patients with systemic sclerosis (SSc), a systematic literature search was performed using Medline, EMBASE, and Cochrane Central Register of Controlled Trials (from 1961 to October 2011). We included meta-analyses, systematic reviews, clinical trials, and high-quality cohort studies published in English or Spanish. Patient populations had to include adults diagnosed with limited cutaneous or diffuse SSc who had associated RP and/or digital ulcers under pharmacological treatment. Efficacy of treatments was evaluated based on: number of RP episodes, RP severity, episode-free time, ulcer improvement/healing, and appearance of new ulcers. We used the Jadad scale of methodological quality to evaluate the quality of randomized clinical trials, and the 2009 Oxford Centre for Evidence-Based Medicine classification for other studies. Of a total of 1617 studies identified, only 27 fulfilled inclusion criteria. Drugs received the following grade recommendations: Grade A for nifedipine, nicardipine, quinapril, IV iloprost, bosentan, tadalafil, and MQx-503; Grade B for beraprost, cicaprost, DMSO, cyclofenil, and atorvastatin; and Grade C for misoprostol, prazosin, OPC-2826, enalapril, sildenafil, antioxidant, and stanazolol. Calcium channel blockers, prostanoids, tadalafil, and bosentan received the highest recommendation level for their effectiveness. However, most systematic reviews reviewed just a handful of studies with small sample sizes and short follow-ups. Our review shows that the existing evidence on the efficacy of RP treatment in SSc patients is inconclusive which calls for further research, especially in the form of prospective studies of high quality with long-term follow-ups.

Dades de la publicació

ISSN/ISSNe:: 0172-8172, 1437-160X
Tipus:: Review
Pàgines:: 1447-1459
DOI:: 10.1007/s00296-015-3241-1
PubMed:: 25824427
Factor d'Impacte:: 0,732 SCImago ℠
Quartil:: Q2 SCImago ℠

Documents

No hi ha documents

Mètriques

Filiacions

Lefebvre, PGD:: Hosp Univ Grp Madrid Madrid Monteprincipe Sanchin, Serv Reumatol, Madrid 28050, Spain

CEU Univ San Pablo, Madrid, Spain
Nishishinya, MB:: Hosp Quiron Barcelona, Inst Traumatol, Barcelona, Spain
Pereda, CA:: Clin Mediterraneo, Serv Reumatol, Almeria, Spain
Loza, E:: Inst Salud Musculoesquelet, Madrid, Spain
Giraldo, WAS:: Hosp Univ Grp Madrid Madrid Monteprincipe Sanchin, Serv Reumatol, Madrid 28050, Spain
Ivorra, JAR:: Hosp Univ La Fe, Serv Reumatol, Valencia, Spain
Carreira, P:: Hosp Univ 12 Octubre, Serv Reumatol, Madrid, Spain
Rua-Figueroa, I:: Hosp Univ Gran Canaria Doctor Negrin, Serv Reumatol, Grand Canary, Spain
Pego-Reigosa, JM:: Xerencia Xest Integrada Vigo, SERGAS, Inst Invest Biomed IBI, IRIDIS Grp, Pontevedra, Ourense, Spain
Munoz-Fernandez, S:: Hosp Univ Infanta Sofia, Secc Reumatol, Madrid, Spain

Keywords

Systemic sclerosis; Raynaud's phenomenon; Ulcers; Systematic review; Therapy effectiveness

Campos d'Estudi

Projectes associats

CON-CIENCIA-YV: PILDORAS DE SALUD

FCT-13-7457_FECYT_2013 . MINISTERIO DE ECONOMIA Y COMPETITIVIDAD; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2013