Intervention Review

Iloprost and cisaprost for Raynaud's phenomenon in progressive systemic sclerosis

  1. Janet Pope1,*,
  2. D Fenlon2,
  3. A Thompson3,
  4. Beverley Shea4,
  5. Dan Furst5,
  6. George A Wells6,
  7. Alan Silman7

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 27 APR 1998

Assessed as up-to-date: 29 NOV 1997

DOI: 10.1002/14651858.CD000953


How to Cite

Pope J, Fenlon D, Thompson A, Shea B, Furst D, Wells GA, Silman A. Iloprost and cisaprost for Raynaud's phenomenon in progressive systemic sclerosis. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD000953. DOI: 10.1002/14651858.CD000953.

Author Information

  1. 1

    University of Western Ontario, Dept of Medicine and Epidemiology and Biostatistics, London, Ontario, Canada

  2. 2

    London Health Sciences Centre, University of Western Ontario, Department of Surgery, London, Ontario, Canada

  3. 3

    St Joseph's Health Care, Department of Rheumatology, London, Ontario, Canada

  4. 4

    University of Ottawa, Institute of Population Health, Ottawa, Ontario, Canada

  5. 5

    Virginia Mason Research Center, Seattle, WA 98101, USA

  6. 6

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

  7. 7

    University of Manchester, ARC Epidemiology Research Unit, Manchester, UK

*Janet Pope, Dept of Medicine and Epidemiology and Biostatistics, University of Western Ontario, St. Joseph's Health Care, 268 Grosvenor St, London, Ontario, N6A 4V2, Canada. Janet.Pope@sjhc.london.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 27 APR 1998

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Scleroderma is a connective tissue disease causing fibrosis and commonly affects the skin and internal organs such as the GI tract, lungs, kidney and heart.

Objectives

To assess the effects and toxicity of the following agents:Prostaglandin analogues together with other agents proposed for the treatment of Raynaud's phenomenon (RP) in scleroderma.

Search methods

We searched the Cochrane Controlled Trials Register, and MEDLINE up to 1996 using the Cochrane Collaboration search strategy developed by Dickersin 1994. Key words included: raynaud's or vasospasm, scleroderma or progressive systemic sclerosis or connective tissue disease or autoimmune disease. Current Contents were searched up to and including April 7, 1997. All bibliographies of articles retrieved were searched and key experts in the area were contacted for additional and unpublished data. The initial search strategy included all languages.

Selection criteria

All randomized controlled trials comparing prostaglandin analogues versus placebo were eligible if they reported clinical outcomes within the start of therapy, and if the dropout rate was less than 35%.

Data collection and analysis

Data were abstracted independently by two reviewers (DF, AT). Peto's odds ratios were calculated for all dichotomous outcomes and a weighted mean difference was calculated for all continuous outcomes. A fixed effects or random effects model was used if the data were homogeneous or heterogeneous, respectively.

Main results

Seven randomized trials and 332 patients were included. Five of the seven trials were of parallel design. Five trials compared I.V. Iloprost and one trial studied p.o. Iloprost and another p.o. Cisaprost. Some trials were dose finding trials so various doses of Iloprost were used. Due to different efficacies of I.V. Iloprost, oral Iloprost and oral Cisaprost, the overall efficacy of these drugs was somewhat diluted. Intravenous Iloprost appears to be effective in the treatment of secondary Raynaud's phenomenon.

Authors' conclusions

Intravenous Iloprost is effective in the treatment of Raynaud's phenomenon secondary to scleroderma at decreasing the frequency and severity of attacks and preventing or healing digital ulcers. The effect seems to be prolonged after the intravenous infusion is given. Oral Iloprost may have less efficacy than intravenous Iloprost. However, Cisaprost has minimal or no efficacy when given orally for the treatment of Raynaud's phenomenon secondary to scleroderma.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Iloprost and cisaprost for Raynaud's phenomenon in progressive systemic sclerosis

Scleroderma is a connective tissue disease causing fibrosis and commonly affects the skin and internal organs such as the GI tract, lungs, kidney and heart.

Seven randomized trials and 332 patients were included. Five of the seven trials were of parallel design. Five trials compared I.V. Iloprost and one trial studied p.o. Iloprost and another p.o. Cisaprost. Some trials were dose finding trials so various doses of Iloprost were used. Due to different efficacies of I.V. Iloprost, oral Iloprost and oral Cisaprost, the overall efficacy of these drugs was somewhat diluted. Intravenous Iloprost appears to be effective in the treatment of secondary Raynaud's phenomenon.

Intravenous Iloprost is effective in the treatment of Raynaud's phenomenon secondary to scleroderma at decreasing the frequency and severity of attacks and preventing or healing digital ulcers. The effect seems to be prolonged after the intravenous infusion is given. Oral Iloprost may have less efficacy than intravenous Iloprost. However, Cisaprost has minimal or no efficacy when given orally for the treatment of Raynaud's phenomenon secondary to scleroderma.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Iloprost及cisaprost治療硬皮症的雷諾氏症

硬皮病是結締組織纖維化,引起皮膚及內臟器官如胃腸道、肺、腎、心等病變。

目標

評估前列腺素的衍生物(Prostaglandin analogues)及其他藥物用於治療硬皮病的雷諾氏症的效果與副作用。

搜尋策略

搜尋包括Cochrane Controlled Trials Register, and MEDLINE (直到1999)。關鍵字包括raynaud's or vasospasm, scleroderma or progressive systemic sclerosis or connective tissue disease or autoimmune disease,並諮詢專家以搜尋其它及未發表文獻。

選擇標準

所有隨機對照試驗,比較前列腺素的衍生物(prostaglandin analogues)與安慰劑,且報告臨床效果及患者流失率小於35% 的研究。

資料收集與分析

2個評論者分別評估試驗品質跟擷取數據。本文使用Peto's odds ratios來計算二分法的資料,使用加權平均差異(weighted mean difference:WMD)來分析連續性資料。並用固定效應模型(fixedeffects model)或隨機效應模型(randomeffects model)分別來檢定分析同質或異質性的資料。

主要結論

7篇隨機對照試驗,總共有332例病患包含於分析中。其中5篇是平行對照試驗。5篇比較注射Iloprost,1篇比較口服Iloprost,1篇比較口服Cisaprost。有些Iloprost研究劑量不同,且注射Iloprost、口服Iloprost、口服Cisaprost有不同效果,因此整體效果有些被稀釋。注射Iloprost似乎對治療次發性雷諾氏症有效。

作者結論

注射Iloprost對治療硬皮症引起的次發性雷諾氏症有效,可減少雷諾氏症發作的評率及嚴重性及預防和加速手指潰瘍痊癒,其效果似乎比注射後延長。口服Iloprost效果較差。口服Cisaprost效果極少或無。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結