Improvement of peripheral artery disease with Sildenafil and Bosentan combined therapy in a patient with limited cutaneous systemic sclerosis

Omarjee, Loukman; Fontaine, Cédric; Jaquinandi, Vincent

doi:10.1097/md.0000000000006988

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…[8] Other case reports have shown improvements in PAD-related diseases by the use of SC. [10,11] No side effects related to the continued use of SC was reported, and safety issues restrained to care related to the known side effects of SC (patients using nitrites or with electrocardiographic abnormalities suspected of ischemic cardiovascular alterations).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, SC has been shown to improve glucose metabolism in diabetic patients [7,8]. Daily usage of SC for three months was shown to enhance the insulin sensitivity and to improve the markers of endothelial function [9][10][11]. A mechanism has been proposed correlating improvement in the microcirculation with nitric oxide synthase (type III) activation, which becomes calcium independent upon phosphorylation by cyclic nucleotidedependent protein kinases [12].…”

Section: Introductionmentioning

confidence: 99%

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Type II Diabetes Patients under Sildenafil Citrate: Case Series Showing Benefits and a Side Effect

Zimmermann

Baptista

Tardivo

et al. 2020

Case Reports in Medicine

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Background. Diabetes mellitus is a highly prevalent disease with rapid universal growth. In 2013, there were already 382 million people with diabetes, and it is expected that by 2035, this number will double. Chronic hyperglycemia causes a series of biochemical and structural changes, especially in the eyes, kidneys, heart, arteries, and peripheral nerves, which usually leads to the progression of microvascular disease. Several literature reports showed that the chronic use of phosphodiesterase-5 inhibitors enhances the insulin sensitivity, improves the markers of endothelial function, and helps in the treatment of severe extremity ischemia and pulmonary hypertension. We aim to test the effect of sildenafil citrate (SC) as a glucose and microcirculation regulator in diabetic patients, paying special attention to the consequences of its use in the regulation of blood glucose level. Case Presentation. Two male patients, aged 53 and 73 years, with type II diabetes, using oral hypoglycemic agents and presenting pathology associated with microcirculation alterations and ischemia, were medicated daily with SC. Both patients presented a reduction in the glycemic level, requiring lower doses or no other oral diabetes medications. Patient 1, who presented diabetic foot, was treated in the ambulatory, and patient 2, with chronic obstructive pulmonary disease and consequent mild pulmonary hypertension, was treated in the office. In addition to the clinical improvement of foot wounds and dyspnea due to the increase in microcirculatory perfusion, hypoglycemic episodes were observed in both patients under SC. The patient with pulmonary hypertension experienced one severe hypoglycemia episode and had to be taken to an emergency room. Conclusion. Type 2 diabetic patients may benefit from the use of a phosphodiesterase-5 inhibitor in order to improve the microcirculatory perfusion as well as glycemic control. However, adverse side effects may involve hypoglycemia. Since off-label use of SC in patients suffering from microcirculatory alterations has increased recently, our results showed that more studies are needed to verify the prevalence of hypoglycemia episodes as well as it's possible physiologic mechanism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Type II Diabetes Patients under Sildenafil Citrate: Case Series Showing Benefits and a Side Effect

Zimmermann

Baptista

Tardivo

et al. 2020

Case Reports in Medicine

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“… 10 , 17 For severe refractory ischaemia as in this case, Sildenafil, a phosphodiesterase 5 inhibitor, is normally added. 18 Its effect is also to improve perfusion leading to complete resolution of DUs and lower the risk of new ulcer formation. 19 , 20 Combination therapy of Bosentan and Sildenafil was not possible for her on account of persistently low blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Management of severe Raynaud’s Phenomenon secondary to autoimmune vasculopathy in a young woman

Amissah-Arthur

2021

gmj

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Raynaud’s phenomenon as a cause of acute limb ischaemia in the warmer climates of Sub-Saharan Africa region is uncommon because it is usually thought of as a disease common in cold weather. The prevalence of connective tissue diseases among Black Africans is increasing, and these conditions are associated with secondary Raynaud’s phenomenon and ischaemic digital lesions. We present the case of a 36-year old female with dermatomyositis/systemic sclerosis overlap and secondary Raynaud’s phenomenon who presented with acute limb ischemia (wet gangrene of all digits) in a Tertiary Hospital in Ghana. Young patients presenting with acute limb ischaemia should also be screened for an underlying connective tissue disease. In patients with connective tissue disease, the onset of digital vasculopathy can be rapid and progressive, hence treatment must be prompt and comprehensive to enable better clinical outcomes.

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“…A review of the current literature found only four papers in which combination therapy has been used in RP and DU associated with SSc including three case reports 9–11 and a single retrospective monocentric study, which reported the effect of bosentan and sildenafil on NVC and clinical improvement. 12 Table 1 summarizes these papers and the respective treatment regimens used in each case.…”

Section: Discussionmentioning

confidence: 99%

“…After the addition of bosentan, walking distance improved considerably and limb claudication symptoms were greatly improved. 11…”

Section: Discussionmentioning

confidence: 99%

Combination therapy with bosentan and sildenafil for refractory digital ulcers and Raynaud’s phenomenon in a 30-year-old woman with systemic sclerosis: Case report and literature review

Rademacher

Wincup

Tampe

et al. 2019

Journal of Scleroderma and Related Disorders

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Background: Systemic sclerosis is a rare autoimmune disease characterized by skin and organ fibrosis, and vasculopathy. Raynaud’s phenomenon is almost universally present in systemic sclerosis and can be the most debilitating symptom. Raynaud’s phenomenon may lead to the development of digital ulcers, potentially complicated by infection, tissue necrosis, and auto-amputation. Recommended treatments have variable efficacy. Methods: We report the case of a 30-year-old woman with diffuse systemic sclerosis suffering from severe Raynaud’s phenomenon and digital ulcers with digital tissue necrosis who was treated with combination therapy of an endothelin receptor antagonist and phosphodiesterase 5 inhibitor. In addition, we reviewed the literature on the topic. Results: Previous therapy with calcium-channel blockers, intravenous iloprost, and bosentan had all failed to control symptoms. We added sildenafil in combination with bosentan and observed a rapid and sustained treatment effect. Raynaud’s phenomenon severity, number of attacks, and attack duration decreased within 2 weeks of initiating treatment. Furthermore, this resulted in the healing of established digital ulcers. Conclusion: Our case report suggests that combination therapy may be a feasible treatment for the most severely affected and refractory patients. In our literature review, we found one retrospective study and three additional cases with similarly encouraging results.

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Improvement of peripheral artery disease with Sildenafil and Bosentan combined therapy in a patient with limited cutaneous systemic sclerosis

Cited by 8 publications

References 13 publications

Type II Diabetes Patients under Sildenafil Citrate: Case Series Showing Benefits and a Side Effect

Type II Diabetes Patients under Sildenafil Citrate: Case Series Showing Benefits and a Side Effect

Management of severe Raynaud’s Phenomenon secondary to autoimmune vasculopathy in a young woman

Combination therapy with bosentan and sildenafil for refractory digital ulcers and Raynaud’s phenomenon in a 30-year-old woman with systemic sclerosis: Case report and literature review

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