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Evidence summaries

Calcium-Channel Blockers for Raynaud's Phenomenon in Systemic Sclerosis

Nifedipine is more effective than placebo in reducing the frequency and severity of attacks of Raynaud's phenomenon in systemic sclerosis. Level of evidence: "A"

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.

    References

    • Thompson AE, Shea B, Welch V, Fenlon D, Pope JE. Calcium-channel blockers for Raynaud's phenomenon in systemic sclerosis. Arthritis Rheum 2001 Aug;44(8):1841-7. [PubMed]
    • Kowal-Bielecka O, Fransen J, Avouac J, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis 2017;76(8):1327-1339 [PubMed]

Primary/Secondary Keywords