Management of digital vasculopathy in systemic sclerosis: benefits of multiple courses of endothelin-1 receptor antagonists

Ngcozana, Tanaka; Ong, Voon H; Denton, Christopher P.

doi:10.1136/bcr-2013-203174

Cited by 4 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…515 Scleroderma patients develop autoantibodies directed against the ET A receptor, and antibody titers predict the occurrence of new ischemic digital ulcers, 516 as well as mortality in scleroderma patients with PAH. 517 Korn et al 518 first reported beneficial effects of ERA treatment on development of new ulcers, and observation confirmed by the RAPIDS-1 and RAPIDS-2 (Randomized, Double-Blind, Placebo-Controlled Study With Bosentan on Healing and Prevention of Ischemic Digital Ulcers in Patients With Systemic Sclerosis) found a 30% to 48% reduction in the numbers of new digital ulcers in scleroderma patients after therapy with bosentan (Table S1 in the online-only Data Supplement) 519,520 ; however, treatment did not affect progression and severity of existing digital ulcers 519 (Figure 4). In 2007, bosentan (Tracleer) received regulatory approval by the European Medicines Agency for scleroderma-related digital ulcers.…”

Section: Autoimmune Diseasesmentioning

confidence: 91%

“…In 2007, bosentan (Tracleer) received regulatory approval by the European Medicines Agency for scleroderma-related digital ulcers. 519 In the DUAL-1 and DUAL-2 (Macitentan for the Treatment of Digital Ulcers in Systemic Sclerosis Patients) randomized trials, macitentan (Opsumit ® ), 521 which unlike bosentan is ET A -selective, 80 did not reduce new digital ulcers in scleroderma patients. 521…”

Section: Autoimmune Diseasesmentioning

confidence: 99%

See 1 more Smart Citation

Endothelin: 30 Years From Discovery to Therapy

2019

View full text Add to dashboard Cite

Discovered in 1987 as a potent endothelial cell–derived vasoconstrictor peptide, endothelin-1 (ET-1), the predominant member of the endothelin peptide family, is now recognized as a multifunctional peptide with cytokine-like activity contributing to almost all aspects of physiology and cell function. More than 30 000 scientific articles on endothelin were published over the past 3 decades, leading to the development and subsequent regulatory approval of a new class of therapeutics—the endothelin receptor antagonists (ERAs). This article reviews the history of the discovery of endothelin and its role in genetics, physiology, and disease. Here, we summarize the main clinical trials using ERAs and discuss the role of endothelin in cardiovascular diseases such as arterial hypertension, preecclampsia, coronary atherosclerosis, myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) caused by spontaneous coronary artery dissection (SCAD), Takotsubo syndrome, and heart failure. We also discuss how endothelins contributes to diabetic kidney disease and focal segmental glomerulosclerosis, pulmonary arterial hypertension, as well as cancer, immune disorders, and allograft rejection (which all involve ET A autoantibodies), and neurological diseases. The application of ERAs, dual endothelin receptor/angiotensin receptor antagonists (DARAs), selective ET B agonists, novel biologics such as receptor-targeting antibodies, or immunization against ET A receptors holds the potential to slow the progression or even reverse chronic noncommunicable diseases. Future clinical studies will show whether targeting endothelin receptors can prevent or reduce disability from disease and improve clinical outcome, quality of life, and survival in patients.

show abstract

Section: Autoimmune Diseasesmentioning

confidence: 91%

Section: Autoimmune Diseasesmentioning

confidence: 99%

Endothelin: 30 Years From Discovery to Therapy

2019

View full text Add to dashboard Cite

show abstract

“…The cases presented here have small- to medium-sized palmar arch-level vessel problems that seem continuous with CTD 9 . When ischemic ulceration or pain persists despite conservative and medical treatment, surgical treatment must be considered 10 . Surgical therapy consists of sympathectomy, reconstruction using a bypass graft and venous arterialization 6 .…”

Section: Discussionmentioning

confidence: 99%

“…9 When ischemic ulceration or pain persists despite conservative and medical treatment, surgical treatment must be considered. 10 Surgical therapy consists of sympathectomy, reconstruction using a bypass graft and venous arterialization. 6 Surgical sympathectomy strips the adventitia from the involved arteries to decrease pathologic sympathetic stimulus.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Artery Bypass Graft for the Treatment of Ischemic Ulcer or Severe Pain of Hand in Connective Tissue Diseases

Kim

Eun

2023

Ann Plast Surg

View full text Add to dashboard Cite

Chronic ischemia of the hands and feet is a rare medical condition that requires surgical revascularization. In particular, digital ischemia resulting from connective tissue diseases (CTDs) is among the most important manifestations that negatively affect patients' quality of life. Here, we describe a bypass graft technique for treating digital ischemia. This study aimed to share the considerable benefits of surgical intervention for CTD and present a treatment algorithm. From 2009 to 2020, bypass graft surgery was performed on 10 patients with CTD to relieve their ischemic symptoms or ulceration. Preoperative angiography was performed, and blood distribution patterns were analyzed in detail. Based on the angiographic 4-level analysis, bypass graft surgeries were performed accordingly. The postoperative follow-up was 15 to 72 months. Pain in the hands that underwent the bypass graft surgery improved immediately after surgery. All ulcerations healed and the mean time recorded for ulceration healing was 45.7 days. Here, we propose an appropriate surgical treatment algorithm for managing CTD using arterial bypass graft surgery, and its positive long-term results demonstrate that it is an appropriate option for treating digital ischemia. In conclusion, strict measures with precise preoperative planning can provide satisfactory long-term results in patients with CTD.

show abstract

“…Vasoconstriction following Raynaud phenomenon and structural change in blood vessels including intimal proliferation and obstruction leads to distal extremities specifically digital infarction and ulcer [2]. About 30 to 60% of scleroderma patients developed digital ulcers (DUs) in the course of their disease; these ulcers can affect the quality of life of the patients through the pain experienced and the delay in the healing process [3,4]. Notwithstanding, few studies have investigated the effective treatment processes, specifically for SSc DUs.…”

Section: Introductionmentioning

confidence: 99%

Diltiazem Gel Versus Nitroglycerin Ointment in Healing Process of Scleroderma Digital Ulcers: A Blind Randomized Controlled Trial.

2019

View full text Add to dashboard Cite

Original ArticleAssessing the effect of Diltiazem gel on scleroderma digital ulcers compared to Nitroglycerin ointment and placebo. A single blind randomized controlled trial was done on 90 scleroderma patients, randomly divided to three groups: one receiving Diltazem gel 2%, the other receiving Nitroglycerin ointment 2% and control one receiving Vaseline as placebo for 2 times per day for 8 weeks. The patients' demographic information and disease characteristics were summarized. The longest diameter of the ulcers was measured in 3 groups at the beginning and at the end of the study. The site of the ulcers and the number of new ones were, also, determined for each patient The effect size of the ulcers, in each three groups, was significantly lower at the end of the survey (Diltiazem P value<0.001, Nitroglycerin P value= 0.002 and Control P value= 0.027). However, comparing the induced difference in size of the ulcers between three groups revealed that both Diltiazem gel and Nitroglycerin ointment can significantly more lower the size of ulcers, especially ones at distal part of digits, in comparison to placebo (P value< 0.001, P value=0.003). The number of new ulcers did not have significant difference between three groups. More complications were seen by Nitroglycerin ointment (42%) compared to Diltiazem gel (28%) and placebo (28%). Both Diltiazem gel and Nitroglycerin ointment can be effective in healing of scleroderma digital ulcers; yet, through its lower complications, Diltiazem gel was superior to Nitroglycerin ointment.

show abstract

Management of digital vasculopathy in systemic sclerosis: benefits of multiple courses of endothelin-1 receptor antagonists

Cited by 4 publications

References 17 publications

Endothelin: 30 Years From Discovery to Therapy

Endothelin: 30 Years From Discovery to Therapy

Peripheral Artery Bypass Graft for the Treatment of Ischemic Ulcer or Severe Pain of Hand in Connective Tissue Diseases

Diltiazem Gel Versus Nitroglycerin Ointment in Healing Process of Scleroderma Digital Ulcers: A Blind Randomized Controlled Trial.

Contact Info

Product

Resources

About