Intervention Review

Prazosin for Raynaud's phenomenon in progressive systemic sclerosis

  1. Sarah E Harding2,
  2. Paul C Tingey2,
  3. Janet Pope1,*,
  4. D Fenlon3,
  5. Dan Furst4,
  6. Beverley Shea5,
  7. Alan Silman6,
  8. A Thompson7,
  9. George A Wells8

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 29 NOV 1997

DOI: 10.1002/14651858.CD000956

Database Title

Additional Information

How to Cite

Harding SE, Tingey PC, Pope J, Fenlon D, Furst D, Shea B, Silman A, Thompson A, Wells GA. Prazosin for Raynaud's phenomenon in progressive systemic sclerosis. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD000956. DOI: 10.1002/14651858.CD000956.

Author Information

  1. 1

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

  2. 2

    University of Western Ontario, Department of Medicine, London, Ontario, Canada

  3. 3

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

  4. 4

    Virginia Mason Research Center, Seattle, WA 98101, USA

  5. 5

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

  6. 6

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

  7. 7

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

  8. 8

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

*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: 21 JAN 2009

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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. Most people with scleroderma also have raynaud's phenomenon (RP). One of the possible treatment options for RP in scleroderma is Prazosin.

Objectives

To determine the effects and toxicity of prazosin versus placebo proposed for the treatment of Raynaud's phenomenon (RP) in scleroderma.

Search methods

We searched the Cochrane Controlled Trials Register, and Medline up to December 1996 using the Cochrane Collaboration search strategy developed by Dickersin et al.(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

Randomized controlled trials comparing prazosin versus placebo were eligible if they reported clinical outcomes from the start of therapy. Trials with a greater than 35% dropout were excluded. Trials were included if patients with diffuse or limited scleroderma were the subjects. If patients with other connective tissue diseases or primary Raynaud's were included, the trial was used if the data on the scleroderma patients could be extracted from the paper.

Data collection and analysis

All data were abstracted by two independent and trained reviewers (DF, AT), 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 (Jadad 1996).

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.

Main results

Two trials with a total of 40 patients were included. Prazosin has been found in two randomized controlled cross-over trials to be more effective than placebo in the treatment of Raynaud's secondary to scleroderma. However, the positive response is modest and side effects are not rare in those taking prazosin.

Authors' conclusions

Prazosin is modestly effective in 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

Prazosin 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. Most people with scleroderma also have raynaud's phenomenon (RP). RP is defined as vasospasm of arteries or arterioles causing pallor and at least one other colour change upon reperfusion such as cyanosis or redness. Primary RP occurs in the absence of causes such as connective tissue disease. Secondary RP occurs in people with underlying diseases that affect blood vessels especially scleroderma and lupus. The RP that occurs in scleroderma is often more severe in that there is not only vasospasm but also a fixed blood vessel deficit with intimal proliferation and therefore narrowing of the blood vessels. Raynaud's phenomenon may also be accompanied by digital ulcers which are possibly secondary to ischemia.

One of the possible treatment options for RP in scleroderma is Prazosin.

Two trials with a total of 40 patients were included. Prazosin has been found in two randomized controlled cross-over trials to be more effective than placebo in the treatment of Raynaud's secondary to scleroderma. However, the positive response is modest and side effects are not rare in those taking prazosin.

 

摘要

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

背景

Prazosin用於治療全身性硬化症之雷諾氏症現象

硬皮症是結締組織纖維化，常影響皮膚及內臟器官，如胃腸、肺、腎、心臟。Prazosin是治療硬皮症之雷諾氏症可能選項之一。

目標

評估Prazosin與安慰劑用於治療硬皮症之雷諾氏症的效果與毒性比較

搜尋策略

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。

選擇標準

所有比較Prazosin與安慰劑且報告自開始之臨床結果之隨機對照試驗研究。排除病患流失率超過35% 的研究。

資料收集與分析

兩位作者獨立進行資料摘錄，並由第三位評審驗證。每篇試驗研究的品質由兩位作者獨立使用驗證過的品質評估工具﹝Jadad分數﹞進行評估。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

2篇研究，共有40例病患包含於分析中。在隨機對照交叉試驗研究中，Prazocin治療比安慰劑對硬皮症之雷諾氏症較有效，但正向治療反應是中等且副作用並不罕見。

作者結論

Prazocin治療硬皮症之雷諾氏症是中等有效。

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

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