What is the role of prostaglandins in the treatment of CREST syndrome?

Updated: Oct 05, 2020
  • Author: Jeanie C Yoon, MD; Chief Editor: Dirk M Elston, MD  more...
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Prostaglandin E1, prostacyclin I2, and iloprost (a prostacyclin-I2 analogue) have been evaluated for treatment of Raynaud phenomenon. Prostaglandins may be beneficial because of their vasodilatory and antiplatelet effects. None of these treatments is approved by the US Food and Drug Administration for the treatment of Raynaud phenomenon. Use of these agents should be reserved for patients whose Raynaud phenomenon has resulted in severe ischemia or nonhealing ulcers.

Intravenous infusions of prostacyclin I2 (epoprostenol) in patients with severe Raynaud phenomenon demonstrated substantial clinical improvement. The frequency and duration of attacks were reduced, and significant healing of digital ulcers occurred. Intravenous prostaglandin E1 (alprostadil) has been beneficial in some small studies, particularly in patients with sepsis or necrosis. Intravenous epoprostenol has also been used. [91]

Oral iloprost therapy showed a trend toward improvement of the severity and duration of attacks in patients with scleroderma. Intravenous iloprost reduced the severity, frequency, and duration of Raynaud attacks; helped with ulcer healing [92] ; and showed an increase in quality of life. [93]

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