Fredrick M. Wigley, MD; Robert A. Wise, MD; James R. Seibold, MD; Deborah A. McCloskey, RN; Gregory Kujala, MD; Thomas A. Medsger, MD; Virginia D. Steen, MD; John Varga, MD; Sergio Jimenez, MD; Maureen Mayes, MD; Philip J. Clements, MD; Steven R. Weiner, MD; John Porter, MD; Michael Ellman, MD; Christopher Wise, MD; Lee D. Kaufman, MD; John Williams, MD; William Dole, MD
To evaluate the efficacy and safety of iloprost, a prostacyclin analog, administered intravenously in patients with Raynaud phenomenon secondary to systemic sclerosis.
Multicenter, randomized, parallel placebo-controlled, double-blind study.
University medical centers.
131 patients with systemic sclerosis (101 women, 30 men) ages 20 to 79 years.
Patients were randomly assigned to receive one of two parallel treatments of five daily sequential, 6-hour intravenous infusions of iloprost (0.5 to 2.0 ng/kg per min) or to receive a similar volume of placebo.
Frequency of Raynaud attacks, Raynaud severity score, physician's overall rating of treatment effect, and digital cutaneous lesion healing.
Of the 131 patients enrolled, 126 completed the 5-day infusion and 114 (87%) completed at least 6 weeks of follow-up. Sixty-four patients were randomly assigned to receive iloprost and 67 patients, to receive placebo. The mean weekly number of Raynaud attacks decreased 39.1% with iloprost and 22.2% with placebo (P = 0.005). In addition, the mean percentage of improvement in a global Raynaud severity score during the entire 9-week follow-up was greater in patients given iloprost (34.8%) than in those receiving placebo (19.7%) (P = 0.011). The physician's overall rating of treatment effect showed greater improvement with iloprost than with placebo at week 6 (52.4% compared with 27.4%; P = 0.008) and week 9 (60.9% compared with 26.9%; P < 0.001). At week 3, 14.6% more patients receiving iloprost had 50% or more lesions heal compared with those given placebo (95% CI, 0.9% to 30%). During the infusion, 59 (92%) of the patients receiving iloprost had one or more side effects compared with 38 (57%) of the patients receiving placebo.
Iloprost is effective for the short-term palliation of severe Raynaud phenomenon in patients with systemic sclerosis.
Wigley FM, Wise RA, Seibold JR, McCloskey DA, Kujala G, Medsger TA, et al. Intravenous Iloprost Infusion in Patients with Raynaud Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Placebo-controlled, Double-Blind Study. Ann Intern Med. ;120:199–206. doi: 10.7326/0003-4819-120-3-199402010-00004
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Published: Ann Intern Med. 1994;120(3):199-206.
Cardiology, Rheumatology, Scleroderma.
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