A systematic review 1 included 8 studies with a total of 109 subjects with systemic sclerosis (SSc). Calcium-channel blockers were compared with placebo in 6 crossover trials involving 59 SSc patients. Five of these studies compared nifedipine (at doses of 10-20 mg 3 times daily) with placebo and one study compared nicardipine (60 mg/day) with placebo. Calcium-channel blockers reduced the frequency (WMD -8.31 attacks, 95% CI -15.71 to -0.91 attacks) and severity (SMD -0.69, 95% CI -1.21 to -0.17) of Raynaud's phenomenon (RP) attacks over a 2-week period. This can be thought of as a reduction in severity of ~2.3 cm on a 10-cm visual analog scale (VAS), or >35% improvement compared with placebo. The WMD of nifedipine versus placebo for the reduction in the frequency was -10.21 attacks (95% CI -20.09 to -0.34 attacks) and the SMD for the reduction in the severity of attacks was -0.99 (95% CI -1.74, -0.24), respectively. There was no significant difference between nicardipine and placebo (n=15).There was no significant difference between calcium-channel blockers and intravenous iloprost in frequency, duration or severity of RP attacks, or the number of digital ulcers (1 crossover RCT, 23 patients with SSc). One study compared calcium-channel blockers versus losartan (1 RCT, 27 patients with SSc) and found no significant differences.
EULAR 2 recommends that dihydropyridine-type calcium antagonists, usually oral nifedipine, should be considered as first-line therapy for Raynaud's phenomenon in patients with SSc.
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