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Connective tissue diseases

Digital ulcers unaffected by endothelin blockade

Nature Reviews Rheumatology volume 12, page 374 (2016)Cite this article

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Endothelin 1 is implicated in the pathogenesis of systemic sclerosis (SSc), and the endothelin receptor antagonist (ERA) bosentan has shown efficacy in randomized controlled trials (RCTs) in patients with SSc who have digital ulcers. Surprisingly, the novel ERA macitentan has failed to show efficacy in patients with SSc in two phase III RCTs: DUAL-1 (n = 226) and DUAL-2 (n = 216). In both RCTs, the rate at which new active ischaemic digital ulcers developed over 16 weeks was not significantly different in patients who received placebo and those treated with 3 mg macitentan or 10 mg macitentan. In addition, adverse events — such as headache, peripheral oedema and anaemia — were more common in the treatment groups than among patients who received placebo.

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References

  1. Khanna, D. et al. Effect of macitentan on the development of new ischemic digital ulcers in patients with systemic sclerosis. DUAL-1 and DUAL-2 randomized clinical trials. JAMA 315, 1975–1988 (2016)

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  1. Lydia Shipman
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Shipman, L. Digital ulcers unaffected by endothelin blockade. Nat Rev Rheumatol 12, 374 (2016). https://doi.org/10.1038/nrrheum.2016.87

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