Thursday, 19 Jul 2018

You are here

Cochrane Review: Calcium Channel Blocker Efficacy in Raynaud's

The Cochrane Database has published its review of calcium channel blockers (CCB) in Raynaud's phenomenon, showing CCBs may be useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud's phenomenon, especially with primary Raynaud's.

In their review they distinguished primary Raynaud's phenomenon (not associated with underlying disease) from secondary Raynaud's phenomenon (associated with connective tissue disorders).

They analyzed data from 1946 to 2017, specifically looking for randomized controlled trials (RCTs) comparing calcium channel blockers versus placebo.

They identified 38 RCTs (33 cross-over RCTs) with an average duration of 7.4 weeks and 982 participants.

Nine of the identified trials studied patients with primary Raynaud's phenomenon (N = 365), five studied patients with secondary Raynaud's phenomenon (N = 63), and the rest examined a mixture of patients with primary and secondary Raynaud's phenomenon (N = 554).

Looking at both primary and secondary Raynaud's phenomenon, evidence (moderate quality) from 23 trials with 528 participants shows CCBs were superior to placebo in reducing the frequency of attacks, severity of attacks, and Raynaud's pain (low-quality evidence).

The most common side effects were headache, dizziness, nausea, palpitations, and ankle edema. However, in all trials, no serious adverse events (death or hospitalization) were reported.

Randomized controlled trials with evidence of low to moderate quality showed that CCBs (especially the dihydropyridine class) may be useful in reducing the frequency, duration, severity of attacks, pain and disability associated with Raynaud's phenomenon. Higher doses may be more effective than lower doses and these CCBs may be more effective in primary RP. Although there were more withdrawals due to adverse events in the treatment groups, no serious adverse events were reported.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Nailfold Capillary Density Predicts Dermatomyositis Lung Involvement

In patients with juvenile dermatomyositis (DM), an association was seen between low nailfold capillary density and pulmonary involvement, European researchers reported.

Systemic Sclerosis: More Common than Expected

Systemic sclerosis is more common in the United Kingdom than previously reported, a nationwide population-based study determined.

Best of 2017: Death Rates from Lupus Remain Disproportionately High

The Annals of Internal Medicine reports that despite improving trends in mortality, death rates from systematic lupus erythematosus (lupus) remain high compared to those in the general population, and disparities persist between subpopulations and geographic regions. Underreporting of lupus on death certificates may have resulted in underestimates of mortality rates. 

Best of 2017: Are ANA Tests Unreliable?

Pisetsky and colleagues have reported in the Annals of Rheumatic Disease that ANA tests done on established SLE patients may yield surprisingly disparate results.

While ANA negative lupus was a problem of old assays and the loss of ANA positivity may be seen with chronicity or age, most rheumatologists believe that ANA positivity is an absolute requirement for the diagnosis of systemic lupus erythematosus.

Abatacept Misses in Lupus Nephritis

Dr. Richard Furie, MD, of Northwell Health in New York, presented the findings ofa large phase III trial of abatacept (Orencia) in lupus nephritis showing the agent failed to achieve a complete renal response.

Data presented at EULAR 2018 showed that at one year, a total of 35.1% of patients receiving abatacept achieved complete renal response, as did 33.5% of those randomized to placebo (P=0.73).