Cyclofenil for Raynaud's phenomenon in progressive systemic sclerosis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 27 APR 1998
Assessed as up-to-date: 1 AUG 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Tingey PC, Harding SE, Pope J, Fenlon D, Furst D, Shea B, Silman A, Thompson A, Wells GA. Cyclofenil for Raynaud's phenomenon in progressive systemic sclerosis. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD000955. DOI: 10.1002/14651858.CD000955.
- Publication Status: Edited (no change to conclusions)
- Published Online: 27 APR 1998
Raynaud's is a vasodilatory phenomenon characterised by digital pallor, cyanosis and pain of the extremities. Primary Raynaud's phenomenon has no underlying disease associated with it, while secondary Raynaud's phenomenon is associated with conective tissue disorders such as scleroderma. 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. Cyclofenil is a drug which is well tolerated and may have efficacy in the treatment of RP secondary to scleroderma.
To assess the effects and toxicity of Cyclofenil versus placebo for the treatment of Raynaud's phenomenon (RP) in scleroderma.
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), Medline (January 1966 to August 2007), and Embase (1974 to August 2007) using the Cochrane Collaboration search strategy developed by Dickersin et al.(1994). Current Contents were searched up to and including August 1, 2007. All bibliographies of articles retrieved were searched and key experts in the area were contacted for additional and unpublished data.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.
All randomized controlled trials comparing cyclofenil versus placebo were eligible if they reported clinical outcomes of interest. Trials with dropout rates greater than 30% were excluded.
Data collection and analysis
All data were abstracted by two independent and trained reviewers (SH, PT), and verified by a third reviewer (JP). Each trial was assessed independently by the same two reviewers for its quality using a validated quality assessment tool (Altman 2001).
Peto's odds ratios were calculated for all dichotomous outcomes and a weighted mean difference was carried out on all continuous outcomes. Fixed effects and random effects model were used if the data was homogeneous or heterogeneous, respectively.
One trial with 38 patients was included. There was a trend for Cyclofenil to demonstrate more improvement [OR 1.26 (95% CI 0.33, 4.73)] and more dropouts [OR 1.58 (95% CI 0.42, 5.91)] compared to placebo, but there were no statistically significant differences. The quality score of the one included study was 4 of 5.
There is insufficient evidence either to support or to refute the use of Cyclofenil in the treatment of Raynaud's phenomenon secondary to scleroderma.
Plain language summary
Cyclofenil is a drug that has been studied in the treatment for Raynaud's phenomenon and associated conditions. It is not used for RP and is an anabolic steroid. See also Cochrane review on Stanazol which is also an anabolic steroid.
Raynaud's phenomenon is a disease that causes decreased blood flow and circulation to patients' extremeties. Symptoms include discolouration, pain, and in some severe cases ulceration of the hands and feet. It is most often triggered by cold, stress, and emotional discomfort. Primary Raynaud's phenomenon has no underlying disease associated with it. Secondary Raynaud's phenomenon is most often associated with scleroderma, but may also be related to systemic lupus erythematosus, mixed connective tissue disease, Sjorgen's syndrome, dermatomyositis or rheumatoid arthritis.
Scleroderma is a connective tissue disease causing hardening and commonly affects the skin and internal organs such as the GI tract, lungs, kidney and heart.
One trial which investigated the effect of cyclofenil on 38 patients was included (Blom-Bulow 1981). In general patients treated with Cyclofenil improved more than those treated with placebo, however, these improvements were not statistically significant. Patients treated with cyclofenil reported numerous side effects which in some cases were severe and included an allergic reaction and complications associated with underlying heart conditions.
This review assessed a limited number of studies and therefore the conclusions reached need to be investigated further.
搜尋包括the Cochrane Controlled Trials Register, MEDLINE (直到1996年)。關鍵字包括Raynaud's or vasospasm, scleroderma or progressive systematic sclerosis or connective tissue disease or autoimmune disease，Current Contents搜尋到1997年4月7日。同時手動搜尋文章之參考文獻，及詢問專家其它發表及未發表文獻。初步搜尋包括所有語言。
兩位作者獨立進行資料摘錄。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(fixedeffects model)或隨機效應模型(randomeffects model)分別來檢定分析同質或異質性的資料。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。