On-demand sildenafil (Viagra) shows limited effectiveness for Raynaud phenomenon

1. Sildenafil may be more effective than placebo for treating patients with Raynaud phenomenon.

2. Patient responses to sildenafil treatment showed substantial heterogeneity.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Raynaud phenomenon (RP) occurs when patients experience exaggerated vasoconstriction of the microvasculature in their extremities, often in response to cold or emotional stress. The authors of this study evaluated the role of phosphodiesterase inhibitors in treatment of RP. Specifically, they assessed the efficacy and safety of on-demand sildenafil in RP. Generally, they found it might be an effective treatment for RP. One of the limitations of the study was that there was a heterogeneous response to sildenafil among patients. However the study strengths included adjusting for daily temperature of the patients’ homes.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Evidence-based management of Raynaud’s phenomenon

In-Depth [randomized trial]: The authors of the study conducted a randomized, double-blind, n-of-1 trial to assess the efficacy and safety of on-demand sildenafil in RP. Study outcomes included Raynaud Condition Score (RCS), as well as frequency and daily duration of attacks. Probability data suggested that sildenafil at 40 mg or 80 mg was more effective than placebo. However, the authors only found a modest aggregate effect size (aRV ≥ 0.9 for all outcomes). These results suggested there is not clinical relevant efficacy for patient response to sildenafil when considering the population as a whole.

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