Treatment with iloprost using a portable pump is efficient, safe, and more convenient for the treatment of Raynaud’s phenomenon and digital ulcers in patients with scleroderma, a case report from Portugal shows.
The pump helps patients avoid hospitalization for treatment, which can improve their compliance with iloprost and reduce hospital costs.
Raynaud’s phenomenon, characterized by numb fingers and toes in response to cold or stress, and digital ulcers (sores on fingers and toes) are the main signs of blood vessel disorders. Some forms of Raynaud’s may not be debilitating, but it can have a negative impact on the patient’s quality of life. Other forms can lead to severe infection or amputation.
Iloprost acts as a vasodilator on blood vessels. Iloprost infusion is the recommended treatment by the European League Against Rheumatism (EULAR) to improve the symptoms of Raynaud’s phenomenon and to treat digital ulcers when patients do not respond to oral vasodilators.
A standard treatment regimen consists of iloprost infusions for six hours a day over five consecutive days. Such a regimen requires hospitalization or admission to an out-patient hospital unit. During the procedure, patients can experience side effects such as as nausea, headaches, high blood pressure, or flushing (involuntary redness in the skin, usually in the neck and cheeks, caused by widening of the capillaries).
But new portable devices are available that allow patients to perform their own infusion treatment while going about their normal activities, avoiding the need for hospitals or out-patient settings.
In the study, researchers tested one of these devices, the elastomeric pump, in five patients with scleroderma or mixed connective tissue disease who had Raynaud’s phenomenon or digital ulcers.
Three patients had scleroderma; they were 28, 62, and 73. The younger patient had Raynaud’s phenomenon and insufficient blood flow to the fingers, while the other two presented finger ulcers.
An elastomeric pump works as the elastomeric balloon slowly deflates, infusing medication continuously and at a constant rate through an intravenous tube and into the patient’s catheter. It doesn’t need electricity or a battery.
All patients were treated with two consecutive five-day infusions of iloprost. On the first day, patients attended the hospital, where they were instructed on how to use the pump and were monitored during the first two hours of treatment.
Patients were then allowed to leave the hospital, coming back five days later to refill the pump with another dose of iloprost for the second and last treatment cycle.
At the end of the two treatment cycles (after 10 days), all patients were healed of insufficient blood flow and ulcers in their fingers. And all reported to be able to maintain normal activities during treatment, with none experiencing side effects.
The results show that infusion through an elastomeric pump offers a safe and more convenient option for the treatment of scleroderma patients with iloprost infusions.
The efficacy for healing Raynaud’s phenomenon and digital ulcers seems to be the same as when the treatment is given in the hospital. And, the pump releases iloprost at a constant and slower rate compared to that administered in the hospital, which seems to lead to fewer side effects.
“Our case reports and a brief review of literature prove that iloprost infusion through elastomeric pump is safe, easy, and well tolerated and might even improve patient compliance with treatment,” researchers wrote.
It could also reduce the expense of hospitalizations, they added.
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