[Evidence-based therapy of Raynaud's syndrome].
Raynaud's syndrome has a prevalence of 3-5% in the general population. Despite its high frequency, the majority of available therapies have not been validated in randomized controlled trials. Effective therapies with a high level of evidence include the calcium channel blocker nifedipine. As analyzed by meta-analyses, nifedipine showed improvement of the peripheral circulation, as well as reduction of both the intensity and frequency of attacks in patients with primary and secondary Raynaud's syndrome as compared to placebo. Similar results in a metaanalysis were obtained for intravenous infusions of iloprost in patients with secondary Raynaud's phenomenon associated with systemic sclerosis. In addition, intravenous infusions of iloprost improved healing of fingertip ulcers in patients with systemic sclerosis. Therapies with significant effects in single randomized controlled trials include angiotensin II-receptor type 1 antagonists (losartan), the calcium channel blockers felodipine und amlodipine, serotonin-reuptake-inhibitors (fluoxetine) und phosphodiesterase-V-inhibitors (sildenafil, vardenafil). However, the results for these promising substances have to be confirmed in long-term trials with larger patient numbers.
Distler
M
M
Abt. Dermatologie und Venerologie, Georg-August-Universität Göttingen.
Distler
J
J
Ciurea
A
A
Kyburz
D
D
Müller-Ladner
U
U
Reich
K
K
Distler
O
O
D015106:3',5'-Cyclic-GMP Phosphodiesterases / Q000037:antagonists & inhibitors; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000077300:Bosentan; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; D065128:Endothelin Receptor Antagonists; D011464:Epoprostenol / Q000031:analogs & derivatives / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D011928:Raynaud Disease / Q000175:diagnosis / Q000188:drug therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use*
D015106:3',5'-Cyclic-GMP Phosphodiesterases; D047228:Angiotensin II Type 1 Receptor Blockers; D000077300:Bosentan; D002121:Calcium Channel Blockers; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; D065128:Endothelin Receptor Antagonists; D011464:Epoprostenol; D010726:Phosphodiesterase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors; D013449:Sulfonamides; D014665:Vasodilator Agents; C517381:PDE5A protein, human