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Evidence summaries

Nifedipine for Raynaud's Phenomenon

Nifedipine appears to be more effective than placebo in reducing the frequency and severity of ischaemic attacks in the treatment of primary Raynaud's phenomenon, but causes more adverse effects. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (unclear allocation concealment).

Summary

A Cochrane review [Abstract] 1 included 7 studies with a total of 296 subjects. Four studies examined nifedipine and 3 investigated nicardipine for primary Raynaud's phenomenon. Oral calcium channel blockers (CCBs) decreased the frequency of attacks (SMD 0.23, 95% CI 0.08 to 0.38; 7 studies, n=358) compared with placebo. This translates to 1.72 (95% CI 0.60 to 2.84) fewer attacks per week on CCBs compared to placebo. Nifedipine studies showed a decrease in the frequency of attacks (SMD 0.32, 95% CI 0.10 to 0.54; 4 studies, n=206) translating to 2.41 (95% CI 0.75 to 4.06) fewer attacks per week on nifedipine compared to placebo. Treatment with CCBs appeared to be associated with a number of adverse reactions, including headaches, flushing and oedema (swelling).

Another meta-analysis 2 included 18 studies with a total of 437 subjects with primary Raynaud's phenomenon; 13 studies compared nifedipine vs. placebo, and 5 compared other CCBs vs. placebo. Meta-analysis (17 studies, n=348) showed that CCBs compared with placebo provided a significant reduction in the frequency of ischaemic attacks over a 1-week period, with a WMD of -5.00 (95% CI -9.02 to -0.99), which means a reduction of about five attacks in a 1-week period. The WMD of all CCBs vs. placebo (8 studies, n=147) for reduction in severity of attacks (assessed with a 10-cm visual analogue scale) was -1.39 (95% CI -2.20 to -0.58). With an average mean severity in the placebo group of 4.25, this can be thought of as a 33% reduction in the severity of attacks. Nifedipine reduced the frequency of attacks (WMD -6.05, 95% CI -11.19 to -0.19) and the severity of attacks on a 10-cm visual analogue scale (WMD -1.81, 95% CI -3.08 to -0.54) compared with placebo.

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    References

    • Ennis H, Hughes M, Anderson ME et al. Calcium channel blockers for primary Raynaud's phenomenon. Cochrane Database Syst Rev 2016;(2):CD002069. [PubMed].
    • Thompson AE, Pope JE. Calcium channel blockers for primary Raynaud's phenomenon: a meta-analysis. Rheumatology (Oxford) 2005;44(2):145-50. [PubMed]

Primary/Secondary Keywords