Background Thromboangeitis obliterans (TOA) was described by Leo Buerguer in 1908. It is an occlusive vasculitis which is associated to licit habits such as smoking. Treatment consists of smoking cessation. Patients require ample support with pain medications and vasodilators. Amputation often occurs during the course of the disease.
Objectives To evaluate the efficacy and safety of Bosentan in the treatment of digital ulcers in the course of TOA.
Methods Retrospective study of patients with TOA treated with Bosentan. All patients fulfilled the criteria proposed by Olin (Curr Opin Rheumatol 2006;18:18-24). All patients were having digital ulcers refractory to conventional treatments. An arteriography confirming the vasculopathy was mandatory. All patients were treated previously with Alprodastil during 21 days. Cessation of smoking was required to all patients. Bosentan was used as compassionate use (off-label). The starting dose was in all cases 62.5 mg/day/po during the firs month, followed – if tolerated – by an increase up to 125 mg/12/po.
Results Six patients were recruited, 4 males and 2 females; mean age 49 years (range 60-39). The duration of treatment with bosentan was 12.6 months (range 11-16). All patients healed their ulcers except one that required partial amputation of the tip of the finger because of osteomyelitis. In 5 patients treatment with Bosentan was interrupted because of an excellent evolution with a complete healing of their ulcers. Follow up after interruption: 18.4 months (10-24). There was no recurrence of digital ulcers. Bosentan was well tolerated with absence of adverse reactions.
Conclusions Bosentan might be effective in the treatment of digital ulcers in the course of Thromboangeitis obliterans. Prospective randomized trials would be welcome to confirm the utility of this drug in the treatment of digital ulcers.
Disclosure of Interest None declared