G- CSF treatment for refractory digital ulcers in systemic sclerosis

Treatment of digital ulcers in systemic sclerosis: recent developments and future perspectives

“…Granulocyte colony-stimulating factor (G-CSF) is an immunoregulatory cytokine that exerts antimicrobial, angiogenetic and tissue regenerative effects. Daily treatment with filgrastim 300 μg, a G-CSF analogue, over three consecutive days resulted in a complete resolution of DUs in eight out of ten patients with SSc, while the mean time to DU healing was 1 and a half months [ 63 ].…”

“… Gerodimos et al/2013 [ 58 ] Case report lSSc: 1 1 N/A 1 34 HBOT sessions at 244 kPa (2.4 ATA) for 90 min plus daily ulcers debridement Improvement of the DU Shaito et al/2015 [ 59 ] Case series dSSc: 5, lSSc: 4 9 N/A 9 ESWT: 100 pulses at 0.08–0.25 mJ/mm 2 in 20 areas on both hands and 15 areas on both feet, totaling 7000 pulses once weekly for 9 weeks Decrease in the mean number of DUs per patient Hughes et al/2019 [ 60 ] Case series dSSc: 3, lSSc: 4, SSc-spectrum disorder: 1 8 N/A 7 Irradiation with light therapy 10 J/cm 2 twice weekly for 3 weeks Improvement in DU status during treatment assessed by clinician and patients Case report dSSc 1 Current definition of DU proposed by World Scleroderma Foundation 1 Rheopheresis 2×/weekly every 4 weeks for 3 months. Clinical improvement of current DUs, no new DUs while on treatment Keret et al/2022 [ 63 ] Case series dSSc: 5, lSSc: 5 10 N/A 10 Filgrastim 300 mcg over 3 days Complete resolution of DUs in 80%, reduction in DU number from 2.23 ± 2.20 to 0.50 ± 0.67at 3 months ( p < 0.05) Hachulla et al/2016 [ 66 ] RCT dcSSc: 39, lSSc: 7, lcSSc: 37 83 D6 83 Sildenafil 20 mg or placebo 3×d. for 12 weeks Significant decrease in DU number at weeks 8 and 12.…”