Oral vasodilators for primary Raynaud's phenomenon

Marlene Stewart*, Joanne R. Morling

*Corresponding author for this work

Research output: Contribution to journalLiterature reviewpeer-review

Abstract

Background

Many different drugs have been suggested for the symptomatic treatment of primary Raynaud's phenomenon. Apart from calcium channel blockers, which are considered the drugs of choice, the evidence of the effects of alternative pharmacological treatments is limited. This is an update of a review first published in 2008.

Objectives

To assess the effects of various drugs with vasodilator actions on primary Raynaud's phenomenon.

Search methods

For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched 14 May 2012), CENTRAL (Issue 4, 2012) and clinical trials databases. We contacted one pharmaceutical company and one trial author for additional information. In addition, the reference lists of relevant studies were searched for additional citations. There were no language restrictions.

Selection criteria

Randomised controlled trials evaluating the effects of oral formulations of any drug with vasodilator effects on subjective symptoms in primary Raynaud's phenomenon. Treatment with, or comparison with, calcium channel blockers was not assessed in this review.

Data collection and analysis

Two members of the review team independently assessed the trials for inclusion and their quality and extracted the data. Data extraction included adverse events. We contacted trial authors for missing data.

Main results

Eight studies involving 290 participants were included. Two trials examined the effects of captopril, the rest were single trials on single drugs. All comparisons were with placebo. The methodological quality of most trials was poor.

Enalapril was associated with a small increase in the frequency of attacks per week (difference in means 0.8; 95% CI 0.43 to 1.17). The difference between the intervention groups on a subjective improvement score was non-significant.

There was a significant effect of buflomedil on the frequency of attacks per week (weighted mean difference (WMD) -8.8; 95% CI 17.55 to -0.09), but there was no evidence of effect on the severity score.

The proportion with fewer attacks was significantly higher on moxisylyte than on placebo (relative risk (RR) 4.33; 95% CI 1.36 to 13.81).

For captopril, beraprost, dazoxiben and ketanserin there was no evidence of an effect on the frequency, severity or duration of attacks.

Beraprost and moxisylyte gave significantly more adverse effects than placebo.

Authors' conclusions

Poor methodological quality, small sample sizes and the limited data available resulted in low precision of the statistical results and limited value of the overall results. The overall results show that there is no evidence for an effect of vasodilator drugs on primary Raynaud's phenomenon.

Original languageEnglish
Article numberARTN CD006687
Number of pages54
JournalCochrane Database of Systematic Reviews
Issue number7
DOIs
Publication statusPublished - 11 Jul 2012

Keywords

  • Administration, Oral
  • Randomized Controlled Trials as Topic
  • INOSITOL NICOTINATE
  • Raynaud Disease [drug therapy]
  • Humans
  • PLACEBO-CONTROLLED TRIAL
  • THERAPEUTIC EFFICACY
  • THROMBOXANE SYNTHETASE INHIBITOR
  • PHENOMENON RESISTANT
  • Vasodilator Agents [administration & dosage]
  • KETANSERIN TREATMENT
  • DOUBLE-BLIND TRIAL
  • BLOOD-FLOW
  • COLD-INDUCED VASOCONSTRICTION
  • SELECTIVE ANTAGONIST

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