Fenómeno de Raynaud Primário Quando a Nifedipina ou a Amlodipina Não Controlou a Frequência dos Ataques
No fenómeno de Raynaud primário, um bloqueador dos canais de cálcio é o tratamento oral padrão de primeira linha. Quando esse tratamento não reduz adequadamente a frequência dos ataques vasospásticos, a questão clínica torna-se: qual é o próximo passo adequado?
Condição de Falha
O tratamento anterior — nifedipina (libertação prolongada) ou amlodipina — não atingiu o objetivo de redução na frequência dos ataques do fenómeno de Raynaud. Este objetivo terapêutico não alcançado é o gatilho para a escalada para a próxima linha do 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.