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Geary E, Wormald JCR, Cronin KJ, Giele HP, Durcan L, Kennedy O, O'Brien F, Dolan RT. Toxin for Treating Raynaud Conditions in Hands (The TORCH Study): A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5885. [PMID: 38881966 PMCID: PMC11177805 DOI: 10.1097/gox.0000000000005885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/22/2024] [Indexed: 06/18/2024]
Abstract
Background Raynaud disease of the hands is a complex disorder resulting in inappropriate constriction and/or insufficient dilation in microcirculation. There is an emerging role for botulinum toxin type A (BTX-A) in the treatment armamentarium for refractory Raynaud disease. The aim of this systematic review was to critically evaluate the management of primary and secondary Raynaud disease treated with BTX-A intervention. Methods We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of clinical studies assessing treatment of primary or secondary Raynaud disease with BTX-A by searching Ovid MEDLINE and Embase databases from inception to first August 2023. The review protocol was prospectively registered on the PROSPERO database (CRD42022312253). Results Our search strategy identified 288 research articles, of which 18 studies [four randomized controlled trials (RCTs), two non-RCTs, five case series, and seven retrospective cohort studies] were eligible for analysis. Meta-analysis demonstrated that the probability of pain visual analog scale score improvement with BTX-A intervention was 81.95% [95% confidence interval (74.12-87.81) P = 0.19, heterogeneity I 2 = 26%] and probability of digital ulcer healing was 79.37% [95% confidence interval (62.45-89.9) P = 0.02, heterogeneity I 2 = 56%]. Conclusions Delivery of BTX-A to digital vessels in the hand may be an effective management strategy for primary and secondary Raynaud disease. A definitive, appropriately-powered RCT with objective functional and patient-reported outcome measures is required to accurately assess and quantify the efficacy of BTX-A in Raynaud disease of the hands.
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Affiliation(s)
- Ellen Geary
- From the Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kevin J Cronin
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Henk P Giele
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Laura Durcan
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - Oran Kennedy
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal O'Brien
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roisin T Dolan
- From the Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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2
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Elrosasy A, Abo Zeid M, Cadri S, Fahmy BM, Elzeftawy MA, Mohammed F, Ramadan A. Efficacy and safety of botulinum toxin in treating scleroderma-associated raynaud's phenomenon: a systematic review and meta-analysis. Arch Dermatol Res 2024; 316:122. [PMID: 38630277 DOI: 10.1007/s00403-024-02864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/26/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
- Medical research group of Egypt (MRGE), Negida Academy, Arlington, MA, US
| | | | - Shirin Cadri
- University of medicine and pharmacy Grigore T. Popa, Ia?i, Romania
| | - Belal M Fahmy
- faculty of medicine, Ain shams university, Ain shams, Egypt
| | | | | | - Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
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Kaushik M, Beyer SE, Nashel J, Kholdani C, Dowlatshahi AS, Secemsky EA, Carroll BJ. Advanced Raynaud's disease: A vascular medicine-initiated team-based approach and nationwide cohort analysis. Vasc Med 2024; 29:120-122. [PMID: 38334051 DOI: 10.1177/1358863x231220609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Milan Kaushik
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sebastian E Beyer
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Jennifer Nashel
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cyrus Kholdani
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Arriyan S Dowlatshahi
- Harvard Medical School, Boston, MA, USA
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brett J Carroll
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Yin H, Liu B, Li Q, Yan Q, Lu L. Botulinum toxin for Raynaud's phenomenon associated with systemic sclerosis: comment on the article by Senet et al. Arthritis Rheumatol 2023; 75:486. [PMID: 36209513 DOI: 10.1002/art.42379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Hanlin Yin
- Department of Rheumatology Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Liu
- Department of Rheumatology Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianqian Li
- Department of Rheumatology Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingran Yan
- Department of Rheumatology Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Department of Rheumatology Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Herrick AL. Advances in the Treatment of Systemic Sclerosis. Rheumatology (Oxford) 2022. [DOI: 10.17925/rmd.2022.1.2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Although systemic sclerosis (SSc) is currently incurable, there have been recent advances in treatment. This review article begins by providing a brief background to SSc in terms of disease subtyping and autoantibodies, because both predict disease trajectory and help clinicians to select appropriate monitoring and treatment protocols. Broad principles of management are then described: ‘disease-modifying’ therapies and therapies directed at reducing disease burden and/or progression of SSc-related digital vascular disease and of internal organ involvement. Next, advances in the management of digital vasculopathy, pulmonary arterial hypertension (PAH), interstitial lung disease (ILD) and early diffuse cutaneous SSc are discussed in turn, for example: (a) increased use of phosphodiesterase inhibitors and endothelin receptor antagonists for digital vasculopathy; (b) early recognition and treatment of PAH, including with combination therapies; (c) increased use of mycophenolate mofetil and of nintedanib in ILD; and (d) immunosuppression now as standard practice in early diffuse cutaneous SSc, and autologous haematopoietic stem cell transplantation for highly selected patients with progressive diffuse disease. Finally, future challenges are discussed, including ensuring that all patients with SSc are monitored and treated according to best practice guidelines, and whenever possible giving patients the opportunity to participate in clinical trials.
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