Comparative study of therapeutic effect of diltiazem, nifedipine and felodipine in patients with Reynaud`s phenomenon

Abstract

Calcium channel blockers have been a treatment of first choice for patients with Raynaud's phenomenon (RP) for many years. The aim of the study: The aim of the study is to compare the therapeutic effect and safety of Diltiazem, Nifedipine and Felodipine in patients with primary and secondary RP and to determine their therapeutic effectiveness in patients with severe RP with digital ulcers. Patients and methods: For a period of six months 86 patients with RP were followed up - 19 with systemic sclerosis and 67 with primary RP. The patients are devided into three groups - treated with Diltiazem, Nifedipine and Felodipine. The first group (I) includes 28 patients (n=28) - 6 with scleroderma (3 patients with digital ulcers; n=3) and 22 patients with primary RP. They received Diltiazem at the dose of 60mg 3 times daily. The second group (II) includes 26 patients (n=26) - 6 with scleroderma (3 patients with digital ulcers; n=3) and 21 patients with primary RP. They received Nifedipine at the dose of 10mg 3 times daily. The third group (III) includes 32 patients (n=32) - 8 with scleroderma (4 patients with digital ulcers; n=4) and 24 patients with primary RP. They were treated with Felodipine at the dose of 5mg 2 times daily. For evaluation of the therapeutic efficacy of the medications was used VAS 100mm for global assessment of the severity of RP from the patient and the physician before the treatment and at the follow up. It was performed capillaroscopy. There were followed up also the adverse events in the course of treatment. Results: At the end of the second week we found significant decrease of values of VAS for the global assessment of severity of RP by the patients and by the doctor in groups of patients - I, II and III. In the three groups of patients the frequency and severity of vasospastic episodes was reduced as well as the degree of pain and disability. Capillaroscopy of nail-fold showed incresed blood flow at the end of the second week compared to baseline in the three groups of patients. Healing of digital ulcers we observed in four patients only in the group treated with Felodipine. These three calcium channel blockers that we used in the present study possess good therapeutic effect in patients with RP, which enhances in the sequence: Diltiazem. Scripta Scientifica Medica 2007;39(1):31-34