Background/Purpose

Iloprost is a milestone in the treatment of Raynaud’s Phenomenon (RP). However, it has transient hemodynamic effects due to a very short half-time, thereby a treatment protocol has been never validated and the interval time between infusions is empirical. We aimed at evaluating the short and medium term effects of Iloprost on blood flux, assessed by Laser Doppler (LD), in patients with RP associated to Systemic Sclerosis (SSc). 

Methods

19 SSc patients, aged 55.9±16 (mean ±SD) years with disease duration of 9.3±6 years, have undergone Iloprost infusions (50 ng at 1.5 ng/Kg/min) for 3 consecutive days. The LD flowmetry (Periflux System 5000, Perimed) was performed at baseline and after heating test (heat stimulus of 44 degree centigrade), and ischemic/occlusive test (200 mm/Hg pressure applied by air-bracelet on brachial artery for 3 min) before Iloprost (T0), at the end of 3 consecutive days of treatment (T1), at 24h (T2) and at 7 days (T3) after last administration of Iloprost. During occlusive test, LD evaluated the micro-vessels flux at rest (RF), flux at pick (PF), the percentage variation between RF and PF (RF/PF %), and recovering and hyperemic times before and after occlusion. During heating test, LD evaluated percentage variation between perfusion units before and after heating test (pre-postPUvar%). Comparisons between times were assessed by repeated measures ANOVA. The results are expressed as average of 4 fingers at each time. Statistic significance was set at p<0.05. During the study no variation of the baseline therapy was allowed.

Results

We observed a prompt improvement, even though transient, of LD parameters following Iloprost infusion. A statistically significant difference (p<0.05) (Tab.1) was found for RF/PF%, showing a time decreasing improvement. In particular the percentage difference comparing to T0 was: -10,26% at T1, -7,4% at T2, -7,8% at T3. For percentage variation between perfusion units before and after-heating test (pre-postPUvar%) a decreasing trend were observed, in particular the variation among times comparing to baseline is: +0.54 % at T1, -18.71% at T2, -19.37 % at T3).

TEST	LD Parameters	Baseline (T0)	End of  infusion (T1)	24h after infusion (T2)	7 days after infusion (T3)	p value
OCCLUSION	Resting flux (RF)	86.7±37,1	77.7±45.5	80.2±87	79.9±39.46	0.821
	Flux at Peak (FP)	132.3± 51.1	118.8±46.8	122.4±45.9	121.9±55.9	0.742
	% variation RF/PF	86.6±37	77.7±45	80.2±35	79.8±39	0.000
	Half hyperemic time	16.3±23.9	14.5±32.9	16.05±19.7	15.1±21.6	0.982
	Time at peak	162.1±194.8	147.6±246.1	147.9±144.4	121.8±139.6	0.795
HEATING	% variation pre and post	48.1±28	48.36±32	39.1±21	38.7±24	0.021

Conclusion

Microcirculation hemodynamic changes induced by Iloprost seem to run out within 24h after the last infusion, particularly when assessed by the occlusive test. Although the Iloprost treatment is an important tool in SSc associated RF, is yet necessary to define the suitable timing to obtain long-lasting benefit.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/short-term-effects-of-iloprost-on-micro-vessels-hemodynamics-in-systemic-sclerosis-patients-evaluated-by-laser-doppler-flowmetry/