Long-term evaluation of lung function in patients affected by scleroderma treated with cyclic iloprost infusions

Prostanoids in scleroderma microangiopathy: clinical and pharmacoeconomic comparison between two intravenous regimens

Objectives: Intravenous iloprost (ILO) has widely demonstrated its effectiveness and safety in systemic sclerosis (SSc) patients. Unfortunately, there is no clear consent about dosage, duration, frequency, and infusion modality. The aim of this study was to compare two different therapeutic schemes in the same cohort of consecutive SSc subjects, evaluating differences in terms of effectiveness [digital ulcer (DU) outcome], safety, and direct healthcare costs.Method: This was a retrospective observational study of 47 patients classified with SSc treated with intravenous ILO for severe Raynaud's phenomenon and/or DUs. Two regimens were compared: a continuous inpatient scheme and a daily outpatient scheme. Demographics and clinical data, concomitant therapies, adverse events, and data on resource use and costs were collected.Results: The number of DUs rose slightly with the switch from the continuous to the daily scheme (0.61 ± 1.2 vs 1.1 ± 1.7). Moreover, in the daily scheme there was an increase in the number of therapeutic cycles (2.4 ± 0.7 vs 4.71 ± 1.4, p < 0.001) and an increase in patients treated with other vasoactive drugs. There was a reduction in ILO tolerability and more than half of the patients suspended the treatment. Five patients required hospitalization for severe and refractory DUs in the daily scheme. Moreover, the costs of the two treatments were comparable [median 7174 (range 2748-18 524) EUR vs 6284 (3232-22 706) EUR, p = 0.712].Conclusion: Treatment with a daily scheme of ILO is characterized by worse tolerability and a higher dropout rate compared to a low-flow regimen, with similar costs. We suggest that a low-flow continuous therapeutic scheme is preferable in SSc patients.

Prostanoid therapy for pulmonary arterial hypertension

Epoprostenol and the structurally related compounds treprostinil, iloprost, and beraprost are collectively referred to as prostanoids. The discovery of epoprostenol in 1976 and unequivocal demonstration of its efficacy in 1996 dramatically altered the approach to therapy for pulmonary arterial hypertension (PAH). Development of prostanoids available through multiple routes of administration and the discovery and development of other agents acting through alternative pathways continue to expand the array of therapeutic options. The use of prostanoids in combination with other PAH drugs and for treating pulmonary hypertensive disorders outside of the PAH classification are areas of ongoing research.

Evaluation of finger skin temperature in scleroderma patients cyclically treated with iloprost

OBJECTIVES

To evaluate by computerized digital thermometry (CDT) the effect of cyclic iloprost infusions on finger skin temperature (FST) in scleroderma patients.

METHODS

Twenty-two scleroderma outpatients (one man, 21 women, mean age 54.2 years) underwent three computerized digital thermometries, the first one 3 days before a 5-day cycle of iloprost infusion, the second the day of the fifth infusion soon after the end of the therapy and the third 1 month after. FST was evaluated under basal conditions, immediately after a cold test and after an 18 min recovery period. For comparison CDT was performed in 10 sex and age matched control subjects.

RESULTS

FST was lower in scleroderma patients before iloprost infusion than in the control group either after cold test either at the end of the recovery period while no difference was found before the cold test. Soon after iloprost infusion and 1 month later the FST at the end of the recovery period increased from the pre-treatment value of 27.8 +/- 5.3 to 30.4 +/- 3.5 degrees C and to 30.0 +/- 4.5 degrees C, respectively (P < 0.05 for both values). No substantial differences were found concerning FST before and at the end of the cold test.

CONCLUSION

Iloprost administration for 5 days allows to normalize the FST value after cold exposition not only immediately after the infusions but even at 1 month distance from the therapy. Despite its short half-life the effect of the drug on endothelium is protracted.