Acute and chronic effects of two different intravenous iloprost regimens in systemic sclerosis: a pragmatic non-randomized trial

• Published in: Rheumatology (Oxford, England) England), 2018-08, Vol.57 (8), p.1408-1416
• Main Authors: Schioppo, Tommaso, Orenti, Annalisa, Boracchi, Patrizia, De Lucia, Orazio, Murgo, Antonella, Ingegnoli, Francesca
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adult; Aged; Aged, 80 and over; Blood flow; Capillaries; Chronic effects; Dose-Response Relationship, Drug; Female; Fingers - blood supply; Follow-Up Studies; Humans; Iloprost - administration & dosage; Intravenous administration; Laser-Doppler Flowmetry; Male; Microscopic Angioscopy; Middle Aged; Regional Blood Flow - drug effects; Retrospective Studies; Scleroderma; Scleroderma, Systemic - diagnosis; Scleroderma, Systemic - drug therapy; Scleroderma, Systemic - physiopathology; Systemic sclerosis; Time Factors; Treatment Outcome; Ulcers; Vascularization; Vasodilator Agents - administration & dosage; Young Adult
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/key113

Abstract Objectives I.v. iloprost (ILO) may be used in the treatment of refractory RP and digital ulcers. We aim to evaluate the acute and chronic effects of two different ILO regimens by power Doppler US (PDUS) and nailfold videocapillaroscopy. Methods In this 3-month single-centre pragmatic non-randomized trial, 96 SSc patients were included and stratified according to ILO treatment as: no ILO (group A), ILO once monthly (group B) and ILO for five consecutive days (group C). Resistivity index (RI), finger pulp blood flow and periungual vascularization by PDUS, and sum of capillaries apex width in 1 mm by nailfold videocapillaroscopy were evaluated. Results were adjusted for the average outdoor temperature at the place of residence. Results An acute ILO effect was observed for only finger pulp blood flow in groups B and C (P < 0.001 and P < 0.005, respectively). An acute effect was observed for RI and periungual vascularization only in group B. A progressive increase was observed for other parameters without statistical difference. ILO effects were not observed any longer before the following infusion. Some parameters (finger pulp blood flow in group B and RI in group C) showed a statistically higher increase the lower the outdoor temperature was. Conclusion ILO had an acute effect as assessed by PDUS, especially in group B. By contrast, an ILO chronic effect was not detectable before the following infusion in both treatment groups. More studies are needed to define how often ILO should be administered.