Vasodilators for primary Raynaud's phenomenon
Su KY
Published in Cochrane Database of Systematic Reviews
Methodology
Cochrane systematic review with searches of the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP and ClinicalTrials.gov to 16 November 2020; randomised trials of oral, intravenous and topical vasodilators in primary Raynaud's phenomenon; two authors independently selected studies, applied the Cochrane risk-of-bias tool and extracted data, with certainty assessed by GRADE.
Key Findings
This Cochrane review of 15 randomised trials in 635 people assessed vasodilator drugs (excluding calcium channel blockers) for primary Raynaud's phenomenon. ACE inhibitors slightly increased attack frequency versus placebo (MD 0.79 attacks/week, 95% CI 0.43 to 1.17, low certainty) with no effect on severity or duration; topical nitrates showed no effect on frequency (MD -1.57, 95% CI -4.31 to 1.17, very low certainty); and phosphodiesterase inhibitors showed no difference in frequency, severity, duration or Raynaud Condition Score. Buflomedil reduced attack frequency (MD -8.82, 95% CI -11.04 to -6.60, 31 participants, moderate certainty) and ketanserin reduced attacks (MD -14.0, 95% CI -27.72 to -0.28, very low certainty), while beraprost gave no benefit and more adverse events (RR 1.59, 95% CI 1.05 to 2.42). The authors conclude evidence is insufficient to support vasodilators and that they may even worsen the condition.
Conclusions
Evidence is insufficient to support vasodilator use and suggests it may even worsen disease.
Limitations
Small samples, inconsistent outcome reporting across trials and evidence certainty ranging from very low to moderate; several drugs were tested in only one small study each, and calcium channel blockers, the usual first-line treatment, were not assessed.
Related Health Concerns
Study Details
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