Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts
Identifieur interne : 000006 ( PascalFrancis/Checkpoint ); précédent : 000005; suivant : 000007Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts
Auteurs : Kyle M. Walker [Irlande (pays)] ; Janet Pope [Canada]Source :
- Seminars in arthritis and rheumatism [ 0049-0172 ] ; 2012.
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Abstract
Objectives: There is a need for standardization in systemic sclerosis (SSc) management. Methods: SSc experts (n = 117) were sent 3 surveys to gain consensus for SSc management. Results: First-line therapy for scleroderma renal crisis (SRC) was an angiotensin-converting enzyme inhibitor (ACEi). For SRC there were not many differences between treating mild or severe SRC. In general, Second-line was to add either a calcium channel blocker (CCB) or angiotensin receptor blocker (ARB) and then an alpha-blocker (66% agreed). Endothelin receptor agonists (ERAs) were the first treatment in mild pulmonary arterial hypertension (PAH) (72%), followed by adding a phosphodiesterase-5 inhibitor (PDE5i) (77%) and then a prostanoid (73%). For severe PAH, initial treatment was 1 of the following: a prostanoid (49%), combination of a ERA and a PDE5i (18%), or combination of a ERA and a prostanoid (16%) (71% agreed). For mild Raynaud's phenomenon (RF), after a CCB and adding a PDE5i (35%), trying an ARB (32%) and finally a prostanoid (23%) was suggested. For more severe RF, 54% agreed on adding a PDE5i (45%) or prostanoid (32%) to a CCB. In the prevention of digital ulcers (DU), initial treatment was a CCB (73%), then adding a PDE5i, then use of a ERA, and then a prostanoid (44% agreed). In interstitial lung disease/pulmonary fibrosis, for induction, usually intravenous cyclophosphamide and mycophenolate mofetil (MMF) or azathioprine were chosen. For maintenance, MMF was chosen by three-fourths (56% agreed). For gastroesophageal reflux disease, >50% would exceed the maximum recommended proton pump inhibitor dose if required (72% agreed). For skin involvement after methotrexate, MMF was usually chosen (37% agreement). For SSC-related inflammatory arthritis, methotrexate therapy (60%) was followed by adding corticosteroids (37%) or hydroxychloroquine (31%) (62% agreed). Conclusions: Discrepancies in drug choices occurred in treatment after first line in SSc. Not all algorithms had good agreement. This study provides some guidance for SSc management.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts</title><author><name sortKey="Walker, Kyle M" sort="Walker, Kyle M" uniqKey="Walker K" first="Kyle M." last="Walker">Kyle M. Walker</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Trinity College, Dublin</s1><s2>Dublin</s2><s3>IRL</s3><sZ>1 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Dublin</wicri:noRegion></affiliation></author><author><name sortKey="Pope, Janet" sort="Pope, Janet" uniqKey="Pope J" first="Janet" last="Pope">Janet Pope</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">12-0332401</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 12-0332401 INIST</idno><idno type="RBID">Pascal:12-0332401</idno><idno type="wicri:Area/PascalFrancis/Corpus">000008</idno><idno type="wicri:Area/PascalFrancis/Curation">000058</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000006</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000006</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts</title><author><name sortKey="Walker, Kyle M" sort="Walker, Kyle M" uniqKey="Walker K" first="Kyle M." last="Walker">Kyle M. Walker</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Trinity College, Dublin</s1><s2>Dublin</s2><s3>IRL</s3><sZ>1 aut.</sZ></inist:fA14><country>Irlande (pays)</country><wicri:noRegion>Dublin</wicri:noRegion></affiliation></author><author><name sortKey="Pope, Janet" sort="Pope, Janet" uniqKey="Pope J" first="Janet" last="Pope">Janet Pope</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Seminars in arthritis and rheumatism</title><title level="j" type="abbreviated">Semin. arthritis rheum.</title><idno type="ISSN">0049-0172</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Seminars in arthritis and rheumatism</title><title level="j" type="abbreviated">Semin. arthritis rheum.</title><idno type="ISSN">0049-0172</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Algorithm</term><term>Complication</term><term>Rheumatology</term><term>Scleroderma</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Traitement</term><term>Sclérodermie</term><term>Complication</term><term>Algorithme</term><term>Rhumatologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives: There is a need for standardization in systemic sclerosis (SSc) management. Methods: SSc experts (n = 117) were sent 3 surveys to gain consensus for SSc management. Results: First-line therapy for scleroderma renal crisis (SRC) was an angiotensin-converting enzyme inhibitor (ACEi). For SRC there were not many differences between treating mild or severe SRC. In general, Second-line was to add either a calcium channel blocker (CCB) or angiotensin receptor blocker (ARB) and then an alpha-blocker (66% agreed). Endothelin receptor agonists (ERAs) were the first treatment in mild pulmonary arterial hypertension (PAH) (72%), followed by adding a phosphodiesterase-5 inhibitor (PDE5i) (77%) and then a prostanoid (73%). For severe PAH, initial treatment was 1 of the following: a prostanoid (49%), combination of a ERA and a PDE5i (18%), or combination of a ERA and a prostanoid (16%) (71% agreed). For mild Raynaud's phenomenon (RF), after a CCB and adding a PDE5i (35%), trying an ARB (32%) and finally a prostanoid (23%) was suggested. For more severe RF, 54% agreed on adding a PDE5i (45%) or prostanoid (32%) to a CCB. In the prevention of digital ulcers (DU), initial treatment was a CCB (73%), then adding a PDE5i, then use of a ERA, and then a prostanoid (44% agreed). In interstitial lung disease/pulmonary fibrosis, for induction, usually intravenous cyclophosphamide and mycophenolate mofetil (MMF) or azathioprine were chosen. For maintenance, MMF was chosen by three-fourths (56% agreed). For gastroesophageal reflux disease, >50% would exceed the maximum recommended proton pump inhibitor dose if required (72% agreed). For skin involvement after methotrexate, MMF was usually chosen (37% agreement). For SSC-related inflammatory arthritis, methotrexate therapy (60%) was followed by adding corticosteroids (37%) or hydroxychloroquine (31%) (62% agreed). Conclusions: Discrepancies in drug choices occurred in treatment after first line in SSc. Not all algorithms had good agreement. This study provides some guidance for SSc management.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0049-0172</s0></fA01><fA02 i1="01"><s0>SAHRBF</s0></fA02><fA03 i2="1"><s0>Semin. arthritis rheum.</s0></fA03><fA05><s2>42</s2></fA05><fA06><s2>1</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts</s1></fA08><fA11 i1="01" i2="1"><s1>WALKER (Kyle M.)</s1></fA11><fA11 i1="02" i2="1"><s1>POPE (Janet)</s1></fA11><fA14 i1="01"><s1>Trinity College, Dublin</s1><s2>Dublin</s2><s3>IRL</s3><sZ>1 aut.</sZ></fA14><fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, ON</s2><s3>CAN</s3><sZ>2 aut.</sZ></fA14><fA17 i1="01" i2="1"><s1>Scleroderma Clinical Trials Consortium (SCTC) <sup>1</sup> and Canadian Scleroderma Research Group (CS<sub>RG</sub>)<sub>2</sub></s1><s3>INC</s3></fA17><fA20><s1>42-55</s1></fA20><fA21><s1>2012</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>15333</s2><s5>354000504409580060</s5></fA43><fA44><s0>0000</s0><s1>© 2012 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>28 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>12-0332401</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Seminars in arthritis and rheumatism</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Objectives: There is a need for standardization in systemic sclerosis (SSc) management. Methods: SSc experts (n = 117) were sent 3 surveys to gain consensus for SSc management. Results: First-line therapy for scleroderma renal crisis (SRC) was an angiotensin-converting enzyme inhibitor (ACEi). For SRC there were not many differences between treating mild or severe SRC. In general, Second-line was to add either a calcium channel blocker (CCB) or angiotensin receptor blocker (ARB) and then an alpha-blocker (66% agreed). Endothelin receptor agonists (ERAs) were the first treatment in mild pulmonary arterial hypertension (PAH) (72%), followed by adding a phosphodiesterase-5 inhibitor (PDE5i) (77%) and then a prostanoid (73%). For severe PAH, initial treatment was 1 of the following: a prostanoid (49%), combination of a ERA and a PDE5i (18%), or combination of a ERA and a prostanoid (16%) (71% agreed). For mild Raynaud's phenomenon (RF), after a CCB and adding a PDE5i (35%), trying an ARB (32%) and finally a prostanoid (23%) was suggested. For more severe RF, 54% agreed on adding a PDE5i (45%) or prostanoid (32%) to a CCB. In the prevention of digital ulcers (DU), initial treatment was a CCB (73%), then adding a PDE5i, then use of a ERA, and then a prostanoid (44% agreed). In interstitial lung disease/pulmonary fibrosis, for induction, usually intravenous cyclophosphamide and mycophenolate mofetil (MMF) or azathioprine were chosen. For maintenance, MMF was chosen by three-fourths (56% agreed). For gastroesophageal reflux disease, >50% would exceed the maximum recommended proton pump inhibitor dose if required (72% agreed). For skin involvement after methotrexate, MMF was usually chosen (37% agreement). For SSC-related inflammatory arthritis, methotrexate therapy (60%) was followed by adding corticosteroids (37%) or hydroxychloroquine (31%) (62% agreed). Conclusions: Discrepancies in drug choices occurred in treatment after first line in SSc. Not all algorithms had good agreement. 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Walker</name></noRegion></country><country name="Canada"><noRegion><name sortKey="Pope, Janet" sort="Pope, Janet" uniqKey="Pope J" first="Janet" last="Pope">Janet Pope</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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