RESEARCH - Treatment with bosentan improves myocardial perfusion and function in systemic sclerosis (scleroderma)

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Bosentan improves myocardial function in systemic sclerosis patients

1/18/2007

By: Reuters Health

NEW YORK (Reuters Health), Jan 18 - Short-term treatment with the endothelin

antagonist bosentan improves myocardial perfusion and function in patients

with systemic sclerosis (SSc), according to a report in the December 2006

issue of the Journal of Rheumatology.

Endothelin antagonists are not only useful in SSc when pulmonary arterial

hypertension has occurred, but they also have the potential to be a general

treatment for the disease, Dr. Yannick Allanore from Hopital Cochin in

Paris, France, told Reuters Health.

" The concept is that systemic sclerosis, which is a severe disease

characterized by systemic fibrosis, is at the beginning mainly a vascular

disease, and we hypothesize that using major vascular drugs (calcium channel

blockers, endothelin antagonists, prostacyclins, phosphodiesterase

inhibitors, etc.) from the beginning and at appropriate dosage may interfere

with the fibrotic process which seems secondary, " Dr. Allanore explained.

Based on bosentan's demonstrated efficacy in pulmonary hypertension related

to collagen vascular diseases such as SSc, Dr. Allanore and colleagues

investigated the myocardial effects of bosentan in 18 patients with SSc

using cardiac MRI and tissue-Doppler echocardiography (TDE).

Four weeks of treatment with bosentan increased median myocardial perfusion

index from 0.17 to 0.22, the authors report, a level similar to that seen in

healthy controls.

Peak systolic and diastolic strain rates also increased significantly after

bosentan treatment, the results indicate, although systolic and diastolic

blood pressures were not affected.

There were no serious adverse events during the study, the researchers note,

and none of the lab values were significantly altered by treatment.

" Ideally, a randomized controlled long-term (24-36 months) study would be

needed to compare the cardiovascular changes in the bosentan compared to

placebo group for cardiovascular complications (myocardial function,

pulmonary arterial hypertension, digital ulceration) and to demonstrate the

'protective' effects of the drug regarding the vascular progression of the

disease, " Dr. Allanore commented.

By Will Boggs, M.D.

Last Updated: 2007-01-17 14:11:16 -0400 (Reuters Health)

J Rheumatol 2006;33:2464-2469

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