Retrospective Analysis of Patients with Systemic Sclerosis Using Bosentan for Digital Ulcer: A Ten-Year Single Center Experience

Ali Ekin; Belkıs Nihan Coşkun; Burcu Yağız; Hüseyin Ediz Dalkılıç; Yavuz Pehlivan

Makale detayları

Retrospective Analysis of Patients with Systemic Sclerosis Using Bosentan for Digital Ulcer: A Ten-Year Single Center Experience

Yazarlar:

Ali Ekin | Belkıs Nihan Coşkun | Burcu Yağız | Hüseyin Ediz Dalkılıç | Yavuz Pehlivan

Yayıncı:

Bursa Uludağ University

Ana Başlıklar:

Romatoloji ve Artrit

Dergi:

Uludağ Üniversitesi Tıp Fakültesi Dergisi Vol.49 Issue 1, pp.37-41

Belge Tipi:

Makale

Yayın Tarihi:

9/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001291062

pISSN:

1300-414X

Anahtar kelimeler:

Özet:

 The risk of ischemic digital ulcer DU development is high in systemic sclerosis SS. The use of bosentan, an endothelin receptor antagonist, is recommended in the treatment of DU secondary to SS. In our study, we aimed to raise awareness of clinicians about the side effects that clinicians may encounter as a result of bosentan use and its management by presenting long-term data of patients who used bosentan in the treatment of DU, which is difficult to manage in patients with SS. The most common side effects that develop during bosentan treatment are headache, dizziness, cough, dyspnea, syncope, flushing, elevated liver enzymes and palpitations. In our study, safety data of bosentan were analyzed by evaluating side effects. Of the 25 patients included in the study, 24 96 were female, the median age was 54 years and the mean follow-up period was 15.16 9.01 years. All patients had used at least one vasodilator drug for the treatment of DU. All patients used calcium channel blockers and pentoxifylline, 23 92 patients used iloprost and 11 44 patients used sildenafil andor tadalafil. There were five 20 patients who died during follow-up while on bosentan for reasons not related to drug use. No side effects were observed in these five patients during follow-up. In five patients, the drug was discontinued for different reasons. One of them was discontinued because of pregnancy and the other one was discontinued voluntarily because she said she felt unwell. In three patients, the drug was discontinued because of palpitations in one, headache in one and elevated aminotransferase in the other. The use of bosentan may reduce the development of DU when used alone or in combination with other drugs. The most important point for a clinician in terms of safety while using bosentan is the side effects that may develop and their management. In our study, there was one patient with headache, aminotransferase elevation and palpitations. This study emphasizes that clinicians should be more careful in terms of side effects when using bosentan for digital ulcers that require difficult and laborious treatment management.

 The risk of ischemic digital ulcer DU development is high in systemic sclerosis SS. The use of bosentan, an endothelin receptor antagonist, is recommended in the treatment of DU secondary to SS. In our study, we aimed to raise awareness of clinicians about the side effects that clinicians may encounter as a result of bosentan use and its management by presenting long-term data of patients who used bosentan in the treatment of DU, which is difficult to manage in patients with SS. The most common side effects that develop during bosentan treatment are headache, dizziness, cough, dyspnea, syncope, flushing, elevated liver enzymes and palpitations. In our study, safety data of bosentan were analyzed by evaluating side effects. Of the 25 patients included in the study, 24 96 were female, the median age was 54 years and the mean follow-up period was 15.16 9.01 years. All patients had used at least one vasodilator drug for the treatment of DU. All patients used calcium channel blockers and pentoxifylline, 23 92 patients used iloprost and 11 44 patients used sildenafil andor tadalafil. There were five 20 patients who died during follow-up while on bosentan for reasons not related to drug use. No side effects were observed in these five patients during follow-up. In five patients, the drug was discontinued for different reasons. One of them was discontinued because of pregnancy and the other one was discontinued voluntarily because she said she felt unwell. In three patients, the drug was discontinued because of palpitations in one, headache in one and elevated aminotransferase in the other. The use of bosentan may reduce the development of DU when used alone or in combination with other drugs. The most important point for a clinician in terms of safety while using bosentan is the side effects that may develop and their management. In our study, there was one patient with headache, aminotransferase elevation and palpitations. This study emphasizes that clinicians should be more careful in terms of side effects when using bosentan for digital ulcers that require difficult and laborious treatment management.

 The risk of ischemic digital ulcer DU development is high in systemic sclerosis SS. The use of bosentan, an endothelin receptor antagonist, is recommended in the treatment of DU secondary to SS. In our study, we aimed to raise awareness of clinicians about the side effects that clinicians may encounter as a result of bosentan use and its management by presenting long-term data of patients who used bosentan in the treatment of DU, which is difficult to manage in patients with SS. The most common side effects that develop during bosentan treatment are headache, dizziness, cough, dyspnea, syncope, flushing, elevated liver enzymes and palpitations. In our study, safety data of bosentan were analyzed by evaluating side effects. Of the 25 patients included in the study, 24 96 were female, the median age was 54 years and the mean follow-up period was 15.16 9.01 years. All patients had used at least one vasodilator drug for the treatment of DU. All patients used calcium channel blockers and pentoxifylline, 23 92 patients used iloprost and 11 44 patients used sildenafil andor tadalafil. There were five 20 patients who died during follow-up while on bosentan for reasons not related to drug use. No side effects were observed in these five patients during follow-up. In five patients, the drug was discontinued for different reasons. One of them was discontinued because of pregnancy and the other one was discontinued voluntarily because she said she felt unwell. In three patients, the drug was discontinued because of palpitations in one, headache in one and elevated aminotransferase in the other. The use of bosentan may reduce the development of DU when used alone or in combination with other drugs. The most important point for a clinician in terms of safety while using bosentan is the side effects that may develop and their management. In our study, there was one patient with headache, aminotransferase elevation and palpitations. This study emphasizes that clinicians should be more careful in terms of side effects when using bosentan for digital ulcers that require difficult and laborious treatment management.

 Sistemik sklerozis SSte iskemik dijital ülser DÜ gelişimi riski yüksektir. SSa ikincil gelişen DÜ tedavisinde endotelin reseptör antagonisti olan bosentan kullanımı önerilmektedir. Çalışmamızda SS tanılı hastalarda görülen, tedavi yönetimi zor olan DÜ tedavisinde bosentan kullanan hastaların uzun dönem verilerini sunarak, klinisyenlerin bosentan kullanımı sonucu karşılaşabilecekleri yan etkiler ve yönetimiyle ilgili farkındalık oluşturmayı amaçladık. Bosentan tedavisi sırasında gelişen en sık yan etkiler baş ağrısı, baş dönmesi, öksürük, nefes darlığı, senkop, flushing, karaciğer enzim yüksekliği ve çarpıntıdır. Çalışmamızda bosentanın güvenlik verileri yan etkiler üzerinden değerlendirilerek incelendi. Çalışmaya alınan 25 hastanın 24ü 96 kadın olup, medyan yaş 54 yıl, hastalık ortalama takip süresi 15.16 9.01 yıldı. Hastaların tamamı DÜ tedavisi için en az bir vazodilatatör ilaç kullanmıştı. Tüm hastaların kalsiyum kanal blokeri ve pentoxifilin kullanımı, 23 92 hastanın iloprost, 11 44 hastanın ise sildenafil veveya tadalafil kullanımı vardı. Bosentan kullanırken takip süresince ilaç kullanımına bağlı olmayan sebeplerden exitus olan beş 20 hasta vardı. Bu beş hastanın takipleri süresince yan etki gözlenmedi. Beş hastada ise farklı nedenlerle ilaç kesildi. Biri gebelik nedeniyle, diğeri ise kendini kötü hissettiğini söylediğinden kendi isteğiyle ilaç kesildi. Üç hastanın birinde çarpıntı, birinde baş ağrısı ve diğerinde ise aminotransferaz yüksekliği nedeniyle ilaç kesildi. Bosentan kullanımı DÜ gelişimini tek başına ya da diğer ilaçlarla kombine kullanıldığında azaltabilmektedir. Bosentanı kullanırken bir klinisyen için güvenlik açısından en önemli nokta gelişebilecek yan etkiler ve bunların yönetimidir. Çalışmamızda baş ağrısı, aminotransferaz yüksekliği ve çarpıntı görülen birer hasta vardı. Bu çalışmayla klinisyenlerin zor ve zahmetli bir tedavi yönetimi gerektiren dijital ülserler için bosentan kullanımında yan etkiler açısından daha dikkatli davranmaları gerektiği vurgulanmıştır.

Makale detayları

Retrospective Analysis of Patients with Systemic Sclerosis Using Bosentan for Digital Ulcer: A Ten-Year Single Center Experience

Yazarlar:

Ali Ekin | Belkıs Nihan Coşkun | Burcu Yağız | Hüseyin Ediz Dalkılıç | Yavuz Pehlivan

Yayıncı:

Bursa Uludağ University

Ana Başlıklar:

Romatoloji ve Artrit

Dergi:

Uludağ Üniversitesi Tıp Fakültesi Dergisi Vol.49 Issue 1, pp.37-41

Belge Tipi:

Makale

Yayın Tarihi:

9/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001291062

pISSN:

1300-414X

Sistemik sklerozis

bosentan

dijital ülser

romatolojiSistemik sklerozis

bosentan

dijital ülser

romatoloji

Sayı

Makale detayları

Yazarlar: Ali Ekin | Belkıs Nihan Coşkun | Burcu Yağız | Hüseyin Ediz Dalkılıç | Yavuz Pehlivan

Yayıncı: Bursa Uludağ University

Ana Başlıklar: Romatoloji ve Artrit

Dergi: Uludağ Üniversitesi Tıp Fakültesi Dergisi Vol.49 Issue 1, pp.37-41

Belge Tipi: Makale

Yayın Tarihi: 9/2023

Belge Dili: Türkçe

Document ID (Org No.): 2001291062

pISSN: 1300-414X

Sayı

Yazarlar:

Ali Ekin | Belkıs Nihan Coşkun | Burcu Yağız | Hüseyin Ediz Dalkılıç | Yavuz Pehlivan

Yayıncı:

Bursa Uludağ University

Ana Başlıklar:

Romatoloji ve Artrit

Dergi:

Uludağ Üniversitesi Tıp Fakültesi Dergisi Vol.49 Issue 1, pp.37-41

Belge Tipi:

Makale

Yayın Tarihi:

9/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001291062

pISSN:

1300-414X