Session Information
Session Type: Abstract Submissions (ACR)
An Indirect Comparisons Analysis of Medications used for treatment of Raynaud’s phenomenon
Background/Purpose: There are several pharmacological treatments used for treatment of Raynaud’s phenomenon: calcium channel blockers, endothelin receptor antagonists, phosphodiesterase-5 enzyme inhibitors. The treatments have shown varying efficacy for relieving the symptoms of raynaud’s phenomenon. One of the main determinants of the medications used for treatment of Raynaud’s phenomenon is cost. The objective of this research is to perform a comparison of several pharmacological treatments for raynaud’s phenomenon. The medications that were analyzed were: Bosentan, Vardenafil, Tadalifil, Sildenafil, Udenafil, MQX-503 (a topical nitro formulation), Amlodipine. The main outcomes that were analyzed were Raynaud phenomenon attack frequency (number of attacks per day) and Raynaud condition score (a scale of 1 to 10, with higher scores indicating more severe symptoms).
Methods: Studies were extracted from a computerized literature search of PubMed, MEDLINE and EMBASE of all relevant RCT’s. 8 RCT’s, including 491 patients, were identified. There were two outcomes of interest: Raynaud phenomenon attack frequency (number of attacks per day) and Raynaud condition score. There were several outcomes of interest for safety: headache, nausea, vomiting, dizziness. Studies were included if they provided data at 10 weeks. For each outcome, a fixed-effects meta-analysis was employed to compare each drug to placebo. A mixed-treatment comparisons analysis was then utilized to compare each of these drugs to one another indirectly. Calculation of the probability that each treatment is best was implemented using the Bayesian Markov chain Monte Carlo method.
Results: In terms of Raynaud phenomenon attack frequency at 10 weeks, patients taking Vardenafil only had a 0.01 reduced attack frequency when compared to Amlodipine. In terms of Raynaud phenomenon attack frequency at 10 weeks, patients taking MQX-503 only had a 0.44 reduced attack frequency both were compared to Amlodipine. In terms of Raynaud condition score at 10 weeks, patients taking Vardenafil had a reduced 0.13 reduced Raynaud condition score when compared to Amlodipine (95% CI -2.55 to 2.77). In terms of rank probability, Tadalifil had a 44% chance of being the option most likely to be associated with the lowest Raynaud condition score at 10 weeks. The degree of incoherence (measuring how closely the network fits together) was low for all outcomes.
Conclusion: There are many parameters that determine the selection of a medication in the treatment of Raynaud’s phenomenon such as cost, side effects and tolerability. Our analysis attempts to compare various medications for Raynaud’s phenomenon in a network meta-analysis. The goal was to compare Raynaud phenomenon attack frequency and Raynaud Condition score. Based on the above statistical analysis, Vardenafil and Tadalifil may be considered to be superior options to other medications for reducing Raynaud phenomenon attack frequency and Raynaud condition score at 10 weeks.
Disclosure:
S. Manickam,
None;
E. Donath,
None;
S. Dayanand,
None;
J. Greer,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-indirect-comparisons-analysis-of-medications-used-for-treatment-of-raynauds-phenomenon/