title: Efficacy and tolerability of a selective alpha(2C)-adrenergic receptor blocker in recovery from cold-induced vasospasm in scleroderma patients: a single-center, double-blind, placebo-controlled, randomized crossover study.
abstract: OBJECTIVE
  OPC-28326 is a selective alpha-adrenergic antagonist with preferential binding to the alpha(2C)-adrenergic receptor (alpha(2C)-AR) subtype. This study observed the effect of OPC-28326 on skin temperature and digital blood flow following an acute cold challenge in patients with Raynaud's phenomenon secondary to scleroderma.
  
  
  METHODS
  The study was designed as a single-center, double-blind, placebo-controlled, randomized, 3-period crossover study of OPC-28326 (oral doses of 10 mg or 40 mg) or placebo. The primary outcome measures were the time to recover 50% and 70% of the fall (induced by cold challenge) in baseline digital skin temperature.
  
  
  RESULTS
  Twelve of 13 enrolled patients completed the study. The mean time to achieve 50% and 70% recovery of the change in prechallenge digital skin temperature was shorter after the OPC-28326 40-mg dose than after placebo (50% recovery at 5.8 minutes versus 10.0 minutes [P = 0.02]; 70% recovery at 13.8 minutes versus 19.5 minutes [P = 0.01]). These recovery times tended to be shorter in the 10 mg OPC-28326 group as well, but the difference versus placebo was not significant (50% recovery at 9.0 minutes versus 10.0 minutes [P = 0.65]; 70% recovery at 15.3 minutes versus 19.5 minutes [P = 0.07]). Total digital blood flow tended to be lower prior to the cold challenge and after administration of 40 mg OPC-28326, as compared with that after placebo, but the difference was not significant. Symptoms that were potentially drug-related were reported more frequently with 40 mg OPC-28326 than with 10 mg OPC-28326 or with placebo, but none were serious or sustained.
  
  
  CONCLUSIONS
  OPC-28326 at doses of 10 mg and 40 mg was well tolerated during this study. The shorter time to skin temperature recovery after 40 mg OPC-28326 suggests that selective alpha(2C)-AR blockade improves digital skin perfusion during recovery from cooling in patients with Raynaud's phenomenon secondary to scleroderma.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland 21224, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Wigley
authors.forename: Barbara
authors.initials: B
authors.lastname: White
authors.forename: Gwen
authors.initials: G
authors.lastname: Leatherman
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhong
authors.forename: Holly
authors.initials: H
authors.lastname: Krasa
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kambayashi
authors.forename: Cesare
authors.initials: C
authors.lastname: Orlandi
authors.forename: Frank S
authors.initials: FS
authors.lastname: Czerwiec
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000814:Aniline Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D003080:Cold Temperature / Q000009:adverse effects; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005385:Fingers / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011928:Raynaud Disease / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012039:Regional Blood Flow / Q000187:drug effects; D012595:Scleroderma, Systemic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012881:Skin Temperature / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects
chemical_list: D000317:Adrenergic alpha-Antagonists; D000814:Aniline Compounds; D010880:Piperidines; C400276:OPC 28326