INTRAVENOUS ILOPROST INFUSION IN PATIENTS WITH RAYNAUD PHENOMENON SECONDARY TO SYSTEMIC-SCLEROSIS - A MULTICENTER, PLACEBO-CONTROLLED, DOUBLE-BLIND-STUDY

Objective: To evaluate the efficacy and safety of iloprost, a prostacy clin analog, administered intravenously in patients with Raynaud pheno menon secondary to systemic sclerosis. Design: Multicenter, randomized , parallel placebo-controlled, double-blind study. Setting: University medical centers. Patients: 131 patients with systemic sclerosis (101 women, 30 men) ages 20 to 79 years. Intervention: Patients were random ly assigned to receive one of two parallel treatments of five daily se quential, 6-hour intravenous infusions of iloprost (0.5 to 2.0 ng/kg p er min) or to receive a similar volume of placebo. Measurements: Frequ ency of Raynaud attacks, Raynaud severity score, physician's overall r ating of treatment effect, and digital cutaneous lesion healing. Resul ts: Of the 131 patients enrolled, 126 completed the 5-day infusion and 114 (87%) completed at least 6 weeks of follow-up. Sixty-four patient s were randomly assigned to receive iloprost and 67 patients, to recei ve placebo. The mean weekly number of Raynaud attacks decreased 39.1% with iloprost and 22.2% with placebo (P = 0.005). In addition, the moa n percentage of improvement in a global Raynaud severity score during the entire 9-week follow-up was greater in patients given iloprost (34 .8%) than in those receiving placebo (19.7%) (P = 0.011). The physicia n's overall rating of, treatment effect showed greater improvement wit h iloprost than with placebo at week 6 (52.4% compared with 27.4%; P = 0.008) and week 9 (60.9% compared with 26.9%; P < 0.001). At week 3, 14.6% more patients receiving iloprost had 50% or more lesions heal co mpared with those given placebo (95% CI, 0.9% to 30%). During the infu sion, 59 (92%) of the patients receiving iloprost had one or more side effects compared with 38 (57%) of the patients receiving placebo. Con clusion: iloprost is effective for the short-term palliation of severe Raynaud phenomenon in patients with systemic sclerosis.