Past Coverage of ACR 2014Past Coverage of ACR 2014 Return To RheumReports Home

 

PDE5 Inhibitor Drugs Seem to Help Raynaud’s More Than CCBs

Dr. Janet Pope  Featured
November 17 2014 8:36 PM ET via RheumReports RheumReports

Manickam et al shed some light today on treatment selection for Raynaud's Phenomenon (RP). They performed a network meta-analysis to indirectly compare medications for RP in order to relatively rank them in terms of which are the best treatment options (#1680). This meta-analysis suggested that PDE5 inhibitors reduced the frequency of Raynaud’s episodes and the Raynaud Condition Score more than calcium channel blockers (amilodipine) or topical nitrates.

What was unexpected was that no RP trials with nifedipine were included and vardenafil and tadalafil may have been better than sildenafil. Tadalafil had a 44% chance of being the option most likely to be associated with the lowest Raynaud Condition Score at 10 weeks.

It's important to consider the entry criteria for trials (i.e., if more patients with secondary RP such as associated with SSc are enrolled compared to primary RP, and if patients have already failed a CCB, they will be more difficult to treat). However, the data do confirm the clinical impression that PDE5 inhibitors may help RP more than CCBs in difficult-to-treat patients.

Costs and risk-to-benefit were not taken into account in this analysis.

Head-to-head trials comparing the same patient population (i.e., all secondary RP or a mix of severe primary and secondary RP patients) but without allowing previous CCB failure, would provide more certainty with these conclusions.


Share This Report


About the Author

Dr. Janet Pope
Dr. Janet Pope

Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.

View Full Bio

Trending Reports From ACR 2014