Fenómeno de Raynaud Primario Cuando la Nifedipina o la Amlodipina No Han Controlado la Frecuencia de Ataques
En el fenómeno de Raynaud primario, un bloqueador de canales de calcio es el tratamiento oral estándar de primera línea. Cuando dicho tratamiento no reduce adecuadamente la frecuencia de ataques vasospásticos, la pregunta clínica es: ¿cuál es el siguiente paso apropiado?
La Condición de Fracaso
El tratamiento previo — nifedipina (liberación sostenida) o amlodipina — no logró el objetivo de reducción en la frecuencia de ataques del fenómeno de Raynaud. Este objetivo terapéutico no alcanzado es el desencadenante para la escalada a la siguiente línea del protocolo.
References
DOI: 10.1177/1759720X17740074
- For the practicing rheumatologist, PDE5 inhibitors are therefore probably the most important recent advance in the treatment of ‘uncomplicated’ RP.
- The evidence base for other oral therapies for RP is very weak, other drugs sometimes prescribed include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, α blockers, nitrates, and the selective serotonin receptor uptake inhibitor fluoxetine.
- Fluoxetine has the advantage of not being associated with same vasodilatory side effects as the other drugs mentioned above and may therefore be beneficial in patients intolerant to other therapies.
- PDE5 inhibitors conferred benefit in terms of the mean Raynaud’s Condition Score which decreased, the daily frequency of RP attacks which decreased and the daily duration of RP attacks which decreased.
- 12 weeks’ treatment with losartan conferred benefit in terms of frequency and severity of RP attacks (more so in patients with PRP).
- Frequency and severity of attacks fell on fluoxetine and the authors concluded that larger and placebo-controlled trials were indicated.