Treatment of Raynaud's phenomenon with the selective serotonin reuptake inhibitor fluoxetine.
ABSTRACT To compare fluoxetine, a selective serotonin reuptake inhibitor, with nifedipine as treatment for primary or secondary Raynaud's phenomenon.
Twenty-six patients with primary and 27 patients with secondary Raynaud's phenomenon were assigned randomly to receive 6 weeks of treatment with fluoxetine (20 mg daily) or nifedipine (40 mg daily). Following a 2-week washout period, each group was crossed over to the other treatment arm. The primary outcome variable was the frequency of attacks of Raynaud's phenomenon. Self-reported attack severity, thermographic recovery from cold challenge and plasma levels of von Willebrand factor and soluble P-selectin were also measured.
There was a reduction in attack frequency and severity of Raynaud's phenomenon in patients treated with either fluoxetine or nifedipine, but the effect was statistically significant only in the fluoxetine-treated group (P=0.0002 for attack severity and P=0.003 for attack frequency). Subgroup analysis showed that the greatest response was seen in females and in patients with primary Raynaud's phenomenon. A significant improvement in the thermographic response to cold challenge was also seen in female patients with primary Raynaud's phenomenon treated with fluoxetine but not in those treated with nifedipine. There was no significant treatment effect on von Willebrand factor or soluble P-selectin. No significant adverse effects occurred in the fluoxetine-treated group.
This pilot study confirms the tolerability of fluoxetine and suggests that it would be effective as a novel treatment for Raynaud's phenomenon. Larger and placebo-controlled trials are warranted to assess fluoxetine's therapeutic potential further in this vasospastic condition.
- SourceAvailable from: Federico Perosa[Show abstract] [Hide abstract]
ABSTRACT: Raynaud's phenomenon (RP) is a well defined clinical syndrome characterized by recurrent episodes of digital vasospasm triggered by exposure to physical/chemical or emotional stress. RP has been classified as primary or secondary, depending on whether it occurs as an isolated condition (pRP) or is associated to an underlying disease, mainly a connective tissue disease (CTD-RP). In both cases, it manifests with unique "triple" (pallor, cyanosis and erythema), or "double" color changes. pRP is usually a benign condition, while sRP can evolve and be complicated by acral digital ulcers and gangrene, which may require surgical treatment. The pathogenesis of RP has not yet been entirely clarified, nor it is known whether autoantibodies have a role in RP. Even so, recent advances in our understanding of the pathophysiology have highlighted novel potential therapeutic targets. Aim of this review is to discuss the etiology, epidemiology, risk factors, clinical manifestations, recently disclosed pathogenic mechanisms underlying RP and their correlation with the available therapeutic options, focusing primarily on pRP and CTD-RP.Autoimmunity reviews 01/2014; · 6.37 Impact Factor
Article: [In Process Citation].Reumatología Clínica 03/2008; 4(2):59-66.
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction: Raynaud's phenomenon (RP) is an exaggerated color change of the extremities in response to cold ambient environments and/or emotional stressors. RP may be primary (idiopathic) or secondary to an underlying cause, for example, systemic sclerosis (SSc). An increasing understanding of the pathogenesis of RP is driving the development of new therapeutics and the re-examination of past treatments: several multicenter clinical trials have been conducted in recent years. Areas covered: The aim of this review is to provide the readers with the background to understand the rationale for the current treatments used in patients with RP, to critically appraise the evidence for these treatments and to discuss future treatment approaches. A literature review was undertaken (including publications up to October 2013) using MedLine for English-language papers. Expert opinion: Calcium channel blockers are first-line treatment. A number of other treatment options have been investigated. New treatment options include phosphodiesterase inhibitors and (for SSc-related digital ulceration) endothelin-1 receptor antagonists. There are recurrent methodological concerns in previous clinical trials which should be addressed in designing future clinical trials. Key questions remaining include the role of statins, antioxidants, antiplatelet therapy and anticoagulation in patients with RP, especially SSc-related RP.Expert Opinion on Orphan Drugs. 02/2014;