Sildenafil for Treatment of Digital Ulcers in Patients With Systemic Sclerosis (Sildenafil)

Effect of Sildenafil on Digital Ulcers in Systemic Sclerosis

This is a pilot study analyzing the effect of sildenafil therapy on digital ulcers in systemic sclerosis. We want to analyze ulcer healing by measuring the size of digital ulcers and their count and analyze the effect of sildenafil on angiography.

Study Overview

• Status: Completed
• Conditions: Active Digital Ulcers
• Intervention / Treatment: Drug: Sildenafil therapy

Detailed Description

INVESTIGATOR: Dr. Gabriela Riemekasten Anke Praast Prof. G. R. Burmester Prof. Falk Hiepe

OBJECTIVES:

Sildenafil is a very potent drug in the treatment of digital ulcers secondary to Raynaud´s phenomenon in patients with connective tissue diseases. Probably, sildenafil has a disease-modifying capability improving different signs of a disturbed regulation of vascular tone in connective tissue diseases. Sildenafil can be used over a long period without significant side effects in scleroderma patients and improves disease severity, life quality, and prognosis of patients with connective tissue diseases and secondary Raynaud's phenomenon.

SUBJECTS and CENTERS:

We want to study 10-15 patients with digital ulcers secondary to connective tissue diseases and which are refractory to other drugs, such as calcium channel blockers or iloprost. In this pilot study, patients are treated only in the Charité University Hospital.

INCLUSION/EXCLUSION CRITERIA

1 . Digital gangrene, ulcers in patients with severe secondary Raynaud's phenomenon

2. Stable therapy with vasoactive drugs, such as calcium channel blockers, angiotensin inhibitors/AT II receptor antagonists or pentoxifyllin 4 weeks before and during the treatment with sildenafil.

3. Unchanged immunosuppressive therapy 3 months before treatment with sildenafil

4. No effect of prostacyclin treatment, contraindications for prostacyclins, or other reasons excluding this therapy

EXCLUSION CRITERIA:

1. Therapy with iloprost during the last 4 weeks
2. Sympathectomy during the last 4 weeks
3. TIA, stroke, myocardial infarction during the last 6 months
4. Instable angina pectoris
5. Hemorrhagic diathesis, thrombocytic dysfunction, fibromuscular dysplasia
6. Microangiopathic hemolytic anaemia
7. Azotaemia
8. Hypertonus not adjustable with diuretic, clonidine, ACE inhibitors/AT II antagonists, calcium channel blockers)
9. Left ventricular ejection fraction< 20%
10. Hypotonus < 80/40 mm Hg
11. Positive pregnancy test
12. History of cancer
13. History of gastric/duodenic ulcers without endoscopic proof of complete healing
14. Participation in other studies (currently or during the last 4 weeks)
15. Abuse of alcohol or other drugs, smoker
16. Cardiac failure, use of nitrates

STUDY DESIGN:

This is an open prospective pilot study of one centre determining the effect of a 6 month treatment of sildenafil in patients with acral ulcers in secondary Raynaud's phenomenon due to connective tissue diseases.

Drop out criteria's/ final points:

1 . Any change of the immunomodulating or suppressing therapy (e.g., treatment with cyclophosphamide because of an alveolitis; bolus of steroids > 30 mg/d).

2. No response on the healing of ulcers after 4 weeks of treatment with sildenafil 3. Manifestation of new ulcers/necrosis under sildenafil 4. Escalation of medication with an vascular influence (calcium channel blockers, ACE inhibitors/AT II receptor blockers)

• Study Type: Interventional
• Enrollment (Actual): 17
• Phase: Phase 2

Contacts and Locations

Study Locations

• Germany
  • Berlin, Germany, 10117
    • Riemekasten, PD Dr. med.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Digital gangrene, ulcers in patients with severe secondary Raynaud's phenomenon
2. Stable therapy with vasoactive drugs, such as calcium channel blockers, angiotensin inhibitors/AT II receptor antagonists or pentoxifyllin 4 weeks before and during the treatment with sildenafil.
3. Unchanged immunosuppressive therapy 3 months before treatment with sildenafil
4. No effect of prostacyclin treatment, contraindications for prostacyclins, or other reasons excluding this therapy

Exclusion Criteria:

1. Therapy with iloprost during the last 4 weeks
2. Sympathectomy during the last 4 weeks
3. TIA, stroke, myocardial infarction during the last 6 months
4. Instable angina pectoris
5. Hemorrhagic diathesis, thrombocytic dysfunction, fibromuscular dysplasia
6. Microangiopathic hemolytic anaemia
7. Azotaemia
8. Hypertonus not adjustable with diuretic, clonidine, ACE inhibitors/AT II antagonists, calcium channel blockers)
9. Left ventricular ejection fraction< 20%
10. Hypotonus < 80/40 mm Hg
11. Positive pregnancy test
12. History of cancer
13. History of gastric/duodenic ulcers without endoscopic proof of complete healing
14. Participation in other studies (currently or during the last 4 weeks)
15. Abuse of alcohol or other drugs, smoker
16. Cardiac failure, use of nitrates

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: 1, active ulcers; sildenafil treatment	Drug: Sildenafil therapy; oral use; Other Names: start at 25 mg

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
healing of digital ulcer	6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Decrease of frequency/duration of Raynaud's attacks (monthly)	6 months
Prevention of necroses manifestations	6 months

Collaborators and Investigators

• Sponsor: Charite University, Berlin, Germany
• Investigators: Principal Investigator: Dr. Gabriela Riemekasten, MD, Charité Universitätsklinik Berlin

Study record dates

Study Major Dates

• Study Start: February 1, 2004
• Primary Completion (Actual): November 1, 2004
• Study Completion (Actual): February 1, 2007

Study Registration Dates

• First Submitted: February 14, 2008
• First Submitted That Met QC Criteria: February 19, 2008
• First Posted (Estimate): February 27, 2008

Study Record Updates

• Last Update Posted (Estimate): January 7, 2009
• Last Update Submitted That Met QC Criteria: January 6, 2009
• Last Verified: July 1, 2003

More Information

Terms related to this study

• Keywords: digital ulcers,; systemic sclerosis,; sildenafil,; vasoactive therapies
• Additional Relevant MeSH Terms: Pathologic Processes; Skin Diseases; Connective Tissue Diseases; Sclerosis; Ulcer; Scleroderma, Systemic; Scleroderma, Diffuse; Skin Ulcer; Molecular Mechanisms of Pharmacological Action; Vasodilator Agents; Urological Agents; Enzyme Inhibitors; Phosphodiesterase Inhibitors; Phosphodiesterase 5 Inhibitors; Sildenafil Citrate
• Other Study ID Numbers: SDN-D-002G