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Low versus High-dose Iloprost Therapy Over 21
Days in Patients with Secondary Raynaud's Phenomenon and Systemic Sclerosis:
A Randomized, Open, Single-center Study
ANNEGRET KAWALD, GERD R. BURMESTER, DÖRTE HUSCHER, CORD SUNDERKÖTTER, and GABRIELA RIEMEKASTEN
ABSTRACT. Methods. Fifty patients with SSc were randomized 1:1 for the maximally tolerated dose up to 2 ng/kg body weight per minute or low-dose (0.5 ng/kg bw per min) intravenous iloprost administration, applied for 6 hours daily over 21 days. Effects on RP, ulcer healing, skin thickness, esophageal function, and lung involvement assessed by forced vital capacity (FVC) and DLCO were measured, as well as side effects. Results. Both regimens yielded 70% reduction of digital ulcers, 40% reduction in frequency of RP, and 30% reduction in duration of RP. One year after therapy, the modified Rodnan skin score appeared to be unchanged. FVC and DLCO-SB were stable in 87% and 74% of the patients, respectively. The effect of iloprost on skin thickness and lung function was sustained in a subgroup of patients receiving several courses of iloprost. As assessed by a patient questionnaire, 12% of all patients did not respond to iloprost therapy, but 78% experienced a longlasting effect. Mild side effects were common in both groups, but did not lead to discontinuation of therapy. Conclusion. Low-dose iloprost was shown to be equally effective as high-dose iloprost in longterm treatment and was very effective in therapy of digital ulcers. Registered in www.ClinicalTrials.gov (registration no. NCT00622687). (First Release July 15 2008; J Rheumatol 2008;35:1830-7) Key Indexing Terms:
ILOPROST
From the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; the German Rheumatism Research Centre, Berlin; and the Clinic of Dermatology, University of Muenster, Muenster, Germany. Supported by Schering Deutschland GmbH, the Charité Universitätsmedizin, and the BMBF-funded German Systemic Sclerosis Network (DNSS, BMBF Fkz 01 GM 0310, C2, C6, TP6). A. Kawald, MD; G-R. Burmester, MD, Professor of Medicine, Department of Rheumatology and Clinical Immunology, Charité University Hospital; D. Huscher, Dipl Math, German Rheumatism Research Centre; C. Sunderkötter, MD, Professor of Medicine, Clinic of Dermatology, University of Muenster; G. Riemekasten, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital. Address reprint requests to Dr. G. Riemekasten, Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany. E-mail: gabriela.riemekasten@charite.de Accepted for publication April 5, 2008. |
