MELBOURNE, AUSTRALIA — A recent review has found too little evidence on pharmacological treatments for systemic sclerosis (SSc) digital ulcers (DU) and was unable to promote the development of evidence-based treatment guidelines.
A systematic literature review of seven databases was performed to identify all original research studies of adult patients with SSc DU, including randomized controlled trials (RCTs) and prospective longitudinal observational studies (OBS). The research was led by the University of Melbourne at St Vincent’s Hospital and included participation from VA Healthcare Systems in Palo Alto, CA, and Nashville, TN. Their results were published in the journal Rheumatology.1
The study team identified 47 studies that evaluated the treatment efficacy or safety of pharmacological therapies among 4,250 references. They reported that data from 18 RCTs of 1,927 patients and 29 OBS of 661 patients, at various RoB (total 2,588 patients) showed that intravenous iloprost, phosphodiesterase-5 inhibitors and atorvastatin are effective for the treatment of active DU.
“Bosentan reduced the rate of future DU in two RCTs (moderate RoB) and eight OBS at low to high RoB,” wrote the reviewers, who added, “Two small studies (moderate RoB) indicate that JAK inhibitors may be effective for the treatment of active DU, otherwise there are no data to support the use of immunosuppression or antiplatelet agents in the management of DU.”
The study concluded that, while there are several systemic treatments, across four medication classes there are effective therapies for the management of SSc DU. “However, a lack of robust data means it is not possible to define the optimal treatment regimen for SSc DU. The relatively low quality of evidence available has highlighted further areas of research need,” the researchers said.
- Ross L, Maltez N, Hughes M, Schoones W, et. al. Systemic pharmacological treatment of digital ulcers in systemic sclerosis: a systematic literature review. Rheumatology (Oxford). 2023 Jun 19:kead289. doi: 10.1093/rheumatology/kead289. Epub ahead of print. PMID: 37335850.