AB0703 Prostanoids for Treatment of Secondary Raynaud's Phenomenon: Results From a Prospective Observational Single-Centre Cohort Study
Authors: I.R. Gaisin, Z. Bagautdinova, O. Surnina, N. Maksimov, D. Afanasyev
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Raynaud9s phenomenon (RP) secondary to rheumatic diseases (RD) is associated with significant morbidity (e.g., ulcerations and gangrene).<sup>1</sup> Three groups of specific drugs have been marketed for RP (prostanoids, ERAs and PDE-5 inhibitors).<sup>2</sup> <h3>Objectives</h3> To evaluate the comparative efficacy and safety of two prostanoids (intravenous iloprost and alprostadil) in treatment of secondary RP. <h3>Methods</h3> In 2013 and 2014, all 25 inpatients at the regional clinic with secondary RP were treated with prostanoids [23 females; mean (SD) age 47.5 (10.2) yrs]. 20 (80%) pts had systemic sclerosis (SSc),<sup>3</sup> by 1 (4%) – RA, SLE, dermatomyositis, cryoglobulinaemic vasculitis and overlap-syndrome. Duration of RD was 19.1±9.5 yrs, time since onset of RP 13.2±6.4 yrs. Limited cutaneous SSc (13 pts) manifestated with RP in 54%, diffuse SSc (7 pts) - in 57%. 80% of pts had activity of both RD and RP. 6 pts was treated by intravenous iloprost 25 μg for 3–5 days every 3 months. 10 pts received intravenous alprostadil 20 μg for 10 days every 6 months. III group had alprostadil-switched-to-iloprost (due to alprostadil ineffectiveness; 7 pts) or iloprost-switched-to-alprostadil (due to iloprost side effects; 2 pts) therapy. There were no significant differences between three groups at baseline in Raynaud9s Condition Score (RCS), SSc activity and Health Assessment Questionnaire Disability Index (HAQ-DI). All pts were treated with conventional synthetic DMARDs. <h3>Results</h3> At baseline, the incidence of finger pallor and numbing was 80%, digital pain – 68%, fingertip clefts – 44%, digital tip ulcers – 40%, fingertip pitting scars – 16%. 56% of pts had constant RP symptoms and signs. Joint and muscle involvement had 76% of pts, pulmonary involvement – 68%, heart diseases – 56%. All treatments allowed reducing or stopping digital numbness and pain. About six-sevenths of pts with RP could be classified as good responders to iloprost and two-thirds – to alprostadil. Iloprost reduced the frequency of RP attacks by ∼1.2/day compared with alprostadil (p=0.024) and daily duration of RP attacks by ∼45.3 min in comparison (p=0.015). Treatment with iloprost showed significant benefit on RCS with ∼2.8 difference with alprostadil (p=0.032). After a 24-month follow-up all iloprost pts had healed up digital clefts and ulcers. A trend towards a decrease in HAQ-DI was seen in alprostadil groups, and significant HAQ-DI reduction – in iloprost. Treatment with iloprost was associated with a trend towards improvements in pulmonary hypertension and functions. Both prostanoids were well tolerated, except for incidents of tachycardia and hypotension in 2 iloprost pts. <h3>Conclusions</h3> Alprostadil has significant but moderate efficacy in secondary RP. Iloprost is superior to alprostadil and might be recommended not only for severe RP but for preventing digital ulcers. <h3>References</h3> Wigley FM. Clinical practice. Raynaud9s phenomenon. N Engl J Med 2002;347:1001–1008. Kowal-Bielecka O, Landewé R, Avouac J, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann Rheum Dis 2009;68:620–628. van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013;72:1747–1755. <h3>Disclosure of Interest</h3> None declared