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Iloprost may ease Raynaud’s syndrome, prevent digital ulcers

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Iloprost outperformed alprostadil in treating secondary Raynaud’s syndrome and may prevent digital ulcers from developing, according to study findings.

A group of 25 patients with secondary Raynaud’s syndrome (RS) who presented to a regional clinic in Izhevsk, Russian Federation, and were treated with prostanoids between 2013 and 2014 were studied. Twenty patients had systemic sclerosis, and one patient each had rheumatoid arthritis, systemic lupus erythematosus, cryoglobulinemic vasculitis or overlapping diseases. Twenty-three of the patients were women.

Baseline RS condition scores, disease activity and Health Assessment Questionnaire Disability Index (HAQ-DI) were similar between the groups. The incidence of finger pallor and numbness was 80%, digital pain was reported by 68% of patients, fingertip clefts were reported by 44% of patients, 40% of patients had digital tip ulcerations and 16% had fingertip pitting scars. Symptoms of RS were constant in 56% of the patients, and joint and muscular involvement were observed in 76% of patient. Pulmonary involvement was present in 68% of patients, and 56% had heart disease.

Six patients were treated with 25 µg intravenous iloprost for 3 days to 5 days every 3 months and 10 patients received 20 µg intravenous alprostadil for 10 days every 6 months. A third group received alprostadil and later switched to iloprost or switched from iloprost to alprostadil.

Approximately six-sevenths of patients responded well to iloprost, and two-thirds of the patients responded to alprostadil, according to the researchers. The frequency of RS symptom onset was reduced by about 1.2 days with iloprost compared with alprostadil, and the duration of attacks was reduced by about 45 minutes compared with alprostadil treatment. Additionally, Raynaud’s condition score improved by 2.8 more points compared with alprostadil.

Patients who received iloprost had healed digital clefts and ulcers after 24 months, and a significant reduction in HAQ-DI was observed in patients who received iloprost, whereas only a trend toward reduced HAQ-DI was seen in patients treated with alprostadil. A trend toward improvement in pulmonary hypertension and function was seen in patients who received iloprost.

Both prostanoids were tolerated well by all but two patients who had tachardia and hypotension in patients treated with iloprost, according to the researchers. – by Shirley Pulawski

Reference:

Gaisin IR, et al. Paper #AB0703. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology; June 10-13, 2015; Rome.

Disclosure: The researchers report no relevant financial disclosures.