Use of vasoactive/vasodilating drugs for systemic sclerosis (SSc)-related digital ulcers (DUs) in expert tertiary centres: results from the analysis of the observational real-life DeSScipher study.
- Blagojevic J Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, University of Florence, Florence, Italy. jelena308@hotmail.com.
- Abignano G Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy.
- Avouac J Department of Rheumatology, University of Paris Descartes, Paris, France.
- Cometi L Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, University of Florence, Florence, Italy.
- Frerix M Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany.
- Bellando-Randone S Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, University of Florence, Florence, Italy.
- Guiducci S Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, University of Florence, Florence, Italy.
- Bruni C Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, University of Florence, Florence, Italy.
- Huscher D Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Jaeger VK Department of Rheumatology, University of Basel, Basel, Switzerland.
- Lóránd V Department of Rheumatology and Immunology, University of Pécs, Pecs, Hungary.
- Maurer B Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.
- Nihtyanova S Department of Rheumatology, University College London, Royal Free Hospital, London, UK.
- Riemekasten G Clinic of Rheumatology and Clinical Immunology, University of Lübeck, Lubeck, Germany.
- Siegert E Department of Rheumatology and Clinical Immunology, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Tarner IH Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany.
- Vettori S Rheumatology Section, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
- Walker UA Department of Rheumatology, University of Basel, Basel, Switzerland.
- Czirják L Department of Rheumatology and Immunology, University of Pécs, Pecs, Hungary.
- Denton CP Department of Rheumatology, University College London, Royal Free Hospital, London, UK.
- Distler O Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.
- Allanore Y Department of Rheumatology, University of Paris Descartes, Paris, France.
- Müller-Ladner U Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik GmbH, Campus of the Justus-Liebig University Giessen, Bad Nauheim, Germany.
- Moggi-Pignone A Department of Experimental and Clinical Medicine, Department of Emergency, Division of Medicine IV AOUC, University of Florence, Florence, Italy.
- Matucci-Cerinic M Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, University of Florence, Florence, Italy.
- Del Galdo F NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- 2019-05-22
Published in:
- Clinical rheumatology. - 2020
Digital ulcer
Management
Systemic sclerosis
Adult
Aged
Bosentan
Drug Therapy, Combination
Europe
Female
Fingers
Humans
Iloprost
Male
Middle Aged
Prospective Studies
Scleroderma, Systemic
Sildenafil Citrate
Skin Ulcer
Treatment Outcome
Vasodilator Agents
Wound Healing
English
INTRODUCTION
DeSScipher is the first European multicentre study on management of systemic sclerosis (SSc), and its observational trial 1 (OT1) evaluated the efficacy of different drugs for digital ulcer (DU) prevention and healing. The aim of this study was to assess current use of vasoactive/vasodilating agents for SSc-related DU in the expert centres by analysing the baseline data of the DeSScipher OT1.
METHOD
Baseline characteristics of patients enrolled in the OT1 and data regarding DU were analysed.
RESULTS
The most commonly used drugs, in both patients with and without DU, were calcium channel blockers (CCBs) (71.6%), followed by intravenous iloprost (20.8%), endothelin receptor antagonists (ERAs) (20.4%) and phosphodiesterase 5 (PDE-5) inhibitors (16.5%). Of patients, 32.6% with DU and 12.8% without DU received two drugs (p < 0.001), while 11.5% with DU and 1.9% without DU were treated with a combination of three or more agents (p < 0.001). Sixty-five percent of the patients with recurrent DU were treated with bosentan and/or sildenafil. However, 64 out of 277 patients with current DU (23.1%) and 101 (23.6%) patients with recurrent DU were on CCBs alone.
CONCLUSIONS
Our study shows that CCBs are still the most commonly used agents for DU management in SSc. The proportion of patients on combination therapy was low, even in patients with recurrent DU: almost one out of four patients with current and recurrent DU was on CCBs alone. Prospective analysis is planned to investigate the efficacy of different drugs/drug combinations on DU healing and prevention. Key Points • The analysis of DeSScipher, the first European multicentre study on management of SSc, has shown that the most commonly used vasoactive/vasodilating drugs for DU were CCBs, followed by intravenous Iloprost, ERAs and PDE-5 inhibitors. • More than half of the patients with recurrent DU received bosentan and/or sildenafil. • However, the proportion of patients on combination therapy of more than one vasoactive/vasodilating drug was low and almost one out of four patients with current and recurrent DU was on CCBs alone.
DeSScipher is the first European multicentre study on management of systemic sclerosis (SSc), and its observational trial 1 (OT1) evaluated the efficacy of different drugs for digital ulcer (DU) prevention and healing. The aim of this study was to assess current use of vasoactive/vasodilating agents for SSc-related DU in the expert centres by analysing the baseline data of the DeSScipher OT1.
METHOD
Baseline characteristics of patients enrolled in the OT1 and data regarding DU were analysed.
RESULTS
The most commonly used drugs, in both patients with and without DU, were calcium channel blockers (CCBs) (71.6%), followed by intravenous iloprost (20.8%), endothelin receptor antagonists (ERAs) (20.4%) and phosphodiesterase 5 (PDE-5) inhibitors (16.5%). Of patients, 32.6% with DU and 12.8% without DU received two drugs (p < 0.001), while 11.5% with DU and 1.9% without DU were treated with a combination of three or more agents (p < 0.001). Sixty-five percent of the patients with recurrent DU were treated with bosentan and/or sildenafil. However, 64 out of 277 patients with current DU (23.1%) and 101 (23.6%) patients with recurrent DU were on CCBs alone.
CONCLUSIONS
Our study shows that CCBs are still the most commonly used agents for DU management in SSc. The proportion of patients on combination therapy was low, even in patients with recurrent DU: almost one out of four patients with current and recurrent DU was on CCBs alone. Prospective analysis is planned to investigate the efficacy of different drugs/drug combinations on DU healing and prevention. Key Points • The analysis of DeSScipher, the first European multicentre study on management of SSc, has shown that the most commonly used vasoactive/vasodilating drugs for DU were CCBs, followed by intravenous Iloprost, ERAs and PDE-5 inhibitors. • More than half of the patients with recurrent DU received bosentan and/or sildenafil. • However, the proportion of patients on combination therapy of more than one vasoactive/vasodilating drug was low and almost one out of four patients with current and recurrent DU was on CCBs alone.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1007/s10067-019-04564-8
- PMID 31111363
- Persistent URL
- https://folia.unifr.ch/global/documents/168839
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