BackgroundThromboangeitis obliterans (TOA) was described by Leo Buerguer in 1908. It is an occlusive vasculitis which is associated to licit habits such as smoking. Treatment consists of smoking cessation. Patients require ample support with pain medications and vasodilators. Amputation often occurs during the course of the disease.ObjectivesTo evaluate the efficacy and safety of Bosentan in the treatment of digital ulcers in the course of TOA.MethodsRetrospective study of patients with TOA treated with Bosentan. All patients fulfilled the criteria proposed by Olin (Curr Opin Rheumatol 2006;18:18-24). All patients were having digital ulcers refractory to conventional treatments. An arteriography confirming the vasculopathy was mandatory. All patients were treated previously with Alprodastil during 21 days. Cessation of smoking was required to all patients. Bosentan was used as compassionate use (off-label). The starting dose was in all cases 62.5 mg/day/po during the firs month, followed – if tolerated – by an increase up to 125 mg/12/po.ResultsSix patients were recruited, 4 males and 2 females; mean age 49 years (range 60-39). The duration of treatment with bosentan was 12.6 months (range 11-16). All patients healed their ulcers except one that required partial amputation of the tip of the finger because of osteomyelitis. In 5 patients treatment with Bosentan was interrupted because of an excellent evolution with a complete healing of their ulcers. Follow up after interruption: 18.4 months (10-24). There was no recurrence of digital ulcers. Bosentan was well tolerated with absence of adverse reactions.ConclusionsBosentan might be effective in the treatment of digital ulcers in the course of Thromboangeitis obliterans. Prospective randomized trials would be welcome to confirm the utility of this drug in the treatment of digital ulcers.Disclosure of InterestNone declared
9. Como os autores da Carta ao Editor aven tam, tratava-se na época, de trabalho preliminar, onde procuramos demonstrar metodologicamente ser pos sível recuperar, através da memória do paciente, exposição prévia ao sangue violetado. O estudo cen tral deste projeto está ainda em andamento, e visa, por meio de estudo caso-controle, parear aqueles " casos" principalmente linfomas e leucemias, com " controles" do mesmo Hospital, nos quais se demonstrou a natureza benigna da doença que motivou a consulta.10. Por outro lado, gostaríamos de salientar que a sugestão final dos autores, de se utilizar um estudo prospectivo, seria operacionalmente impraticável por tratar-se de doença de baixa prevalência, crônica, de longo período de incubação, o que demandaria algu mas décadas de seguimento para obtenção do grande número de casos necessário. A nosso ver, estudos de tipo caso-controles; representam a única opção para avaliar fatores de risco, associados a doenças com estas características.11. Finalmente, agradecemos aos autores da Carta ao Editor, pelo interesse despertado, assim como pelas sugestões apresentadas.
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