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Phosphodiesterase Type 5 Inhibition Is a Novel Therapeutic Option in Raynaud Disease
Evren Caglayan, MD;
Michael Huntgeburth, MD;
Thomas Karasch, MD;
Julia Weihrauch, MD;
Nicolas Hunzelmann, MD;
Thomas Krieg, MD;
Erland Erdmann, MD;
Stephan Rosenkranz, MD
Arch Intern Med. 2006;166:231-233.
Background Raynaud disease (RD) is a common disorder affecting 3% to 5% of the healthy population, and occurs in more than 90% of patients with connective tissue diseases. The therapeutic options remain limited, particularly in patients with secondary RD due to connective tissue disease. Theoretical considerations lead to the expectation that phosphodiesterase type 5 inhibitors may improve clinical symptoms and digital blood flow in patients with RD.
Methods We conducted an open-label pilot study in 40 patients with RD, 33 (82%) of whom had secondary and 7 (18%) of whom had primary RD. Digital blood flow was measured by laser-Doppler flowmetry at room temperature and during the cold-exposure test before medical treatment, 1 hour after the initial intake, and after 2 weeks of continuous treatment (10 mg twice a day) with the novel phosphodiesterase type 5 inhibitor vardenafil. Clinical symptoms were recorded by a patient questionnaire and summarized as the Raynaud condition score.
Results Laser-Doppler flowmetry revealed that vardenafil improved digital blood flow in 28 (70%) patients, whereas 12 (30%) did not respond. In individuals responding, digital blood flow significantly increased by a mean ± SEM of 21.0% ± 4.9% and 30.0% ± 5.7% at 1 hour and 2 weeks of treatment at room temperature, respectively, and by 18.8% ± 4.4% and 35.1% ± 7.5% at 1 hour and 2 weeks during the cold-exposure test, respectively (P < .01 for all). Consistently, clinical symptoms improved in 27 (68%) of the 40 patients, and the Raynaud condition score declined from a mean ± SEM of 5.05 ± 0.38 to 3.54 ± 0.31 (P < .001).
Conclusion Our data indicate that phosphodiesterase type 5 inhibition significantly improves peripheral blood flow and clinical symptoms in a large subset of patients with RD and, thus, may provide a novel therapeutic approach in such individuals.
Author Affiliations: Klinik III für Innere Medizin (Drs Caglayan, Huntgeburth, Karasch, Erdmann, and Rosenkranz) and Klinik und Poliklinik für Dermatologie (Drs Weihrauch, Hunzelmann, and Krieg), Universität zu Köln, Köln, Germany.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Phosphodiesterase Inhibitors in Raynaud's Phenomenon
Levien
The Annals of Pharmacotherapy 2006;40:1388-1393.
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