Efficacy of bosentan in patients with refractory thromboangiitis obliterans (Buerger disease)

Abstract

The cornerstone of therapy in thromboangiitis obliterans (TAO) is complete abstinence from tobacco. In addition to discontinuation of cigarette smoking, very few pharmacological and surgical options of controversial efficacy are available to date. New therapeutic options with greater efficacy are clearly needed to properly manage these patients.In this preliminary study, we assessed the effectiveness and safety of bosentan in a case series of 8 adults with TAO and severe ischemic ulceronecrotic lesions who were treated with bosentan after inadequate response to platelet inhibitors, vasodilators, and intravenous alprostadil. Additionally, we reviewed 18 well-documented patients with refractory TAO treated with bosentan, which was previously reported (PubMed 1965–2015). These 26 patients formed the basis of our present analysis. All were current smokers.The median duration of bosentan treatment (SD) was 4.5 ± 4 months (range 3–16). Eleven patients (42%) were unable to completely abstain from smoking during their follow-up. With bosentan treatment, no new ischemic lesions were observed in the target extremities. A complete therapeutic response was achieved in 80% of patients, whereas a partial response was observed in 12%. Two patients (8%) ultimately required amputation despite treatment.After discontinuation of bosentan, patients were followed for a median of 20 ± 14 months (range 3–60). Two patients whose trophic lesions had healed relapsed.When comparing patients who gave up smoking with those who were unable to completely abstain from smoking during follow-up, no significant differences were found in efficacy outcomes. Four patients (15%) developed adverse events, requiring bosentan discontinuation in 1 case.These preliminary data suggest that bosentan may be considered a therapeutic option for treatment of cases of severe TAO refractory to conventional treatment, and merit further evaluation in larger controlled, randomized clinical studies.

Predictive value of serum VEGF, IL‑1 and TNF‑α in the treatment of thromboangiitis obliterans by revascularization

“…Prostaglandin analogues are also beneficial in the treatment of TAO, but there are still some inadequacies in recent effects. Revascularization, sympathectomy, Ilicavor technique and autologous omental fixation are still controversial in the treatment of TAO ( 21 ).…”

“…At present, the main treatment used for TAO includes drug therapy and revascularization. In these methods the medical team tries to enrich the collateral vessels, increase the blood supply of the limb ischemic area and reduce the blood viscosity ( 5 , 6 ). Usually, antiplatelet and vasodilator drugs are used for the treatment of TAO, these includes 5-HT2 receptor antagonists, prostaglandins, and vascular endothelin-1 receptor antagonists.…”

Levistilide A Ameliorates NLRP3 Expression Involving the Syk-p38/JNK Pathway and Peripheral Obliterans in Rats

“…Few pharmacological and surgical options are available to treat TAO other than TAO therapy in addition to the discontinuation of cigarette smoking [ 45 ]. The frequent use of high-potency vasodilators, such as iloprost, bosentan, sildenafil, or alprostadil, relieves symptoms and reduces the risk of amputation.…”

Para-Clinical and Immunological Evaluation in Buerger's Disease as a Suspected Autoimmune Disease: Case Series

“…Thromboangiitis obliterans, also known as Buerger's disease, is a type of vascular obstructive syndrome that is usually associated with the use of tobacco derivatives and cigarettes (1,2). The reason of this obstruction is frequent and progressive inflammation, and a blood clotting in the vessels (1,3,4).…”