Sudden Winter Iloprost Withdrawal in Scleroderma Patients During COVID-19 Pandemic

Overview

Journal Microvasc Res

Specialty Cardiology & Vascular Diseases

Date 2022 Jul 14

PMID 35835174

Authors

Enrico De Lorenzis

Gerlando Natalello

Lucrezia Verardi

Pier Giacomo Cerasuolo

Laura Gigante

Maria Antonietta DAgostino

Silvia Laura Bosello

Affiliations

Soon will be listed here.

Abstract

Introduction: Intravenous iloprost is currently recommended in the treatment of Raynaud's phenomenon (RP) refractory to oral therapy and of digital ulcers (DUs) related to systemic sclerosis (SSc). In real-life practice there is a huge heterogeneity about the Iloprost regimens used.

Methods: A survey was carried out on SSc patients that interrupted Iloprost infusion to compare acral vascular symptoms just before Iloprost withdrawal and just after the missed infusion. Severity, and frequency of RP, new DUs onset or aggravation of those pre-existing were reported. Last available capillaroscopic images were also evaluated.

Results: The analysis includes 50 patients. After iloprost withdrawal, 11 patients reported a RP worsening because of enhanced intensity (p = 0.007). Only 8 patients of them also complained of an increased frequency (p = 0.07). None of the patients experienced digital ulcers for the first-time during quarantine. Among the 27 patients with a history of digital ulcers, 9 reported worsening and 7 recurrence of DUs. Overall, 17 patients (34.0 %) complained of a worsening of SSc vascular acral manifestations, namely RP or DUs. Reduced capillary density was associated with RP worsening, in particular, each unit increase of capillary density corresponds to an average 44 % decrease in the odds of RP worsening (OR 0.56, CI 95 % 0.36-0.97, p = 0.037). As for RP worsening, the aggravation of DU was associated with a lower capillary density.

Conclusions: Low capillary density can predict a worsening of both RP and DUs in controlled quarantine conditions within a month after iloprost discontinuation in SSc patients.

Citing Articles

Treatment of digital ulcers in systemic sclerosis: recent developments and future perspectives.

Sagonas I, Daoussis D Clin Rheumatol. 2023; 42(10):2589-2599.

PMID: 36847929 PMC: 10497679. DOI: 10.1007/s10067-023-06511-0.

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