Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis
Background and aimsSystemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients...
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| creator | Guédon, Alexis F Carrat, Fabrice Mouthon, Luc Launay, David Chaigne, Benjamin Pugnet, Grégory Lega, Jean-Christophe Hot, Arnaud Cottin, Vincent Agard, Christian Allanore, Yannick Fauchais, Anne Laure Lescoat, Alain Dhote, Robin Papo, Thomas Chatelus, Emmanuel Bonnotte, Bernard Kahn, Jean-Emmanuel Diot, Elisabeth Aouba, Achille Magy-Bertrand, Nadine Queyrel, Viviane Le Quellec, Alain Kieffer, Pierre Amoura, Zahir Granel, Brigitte Gaultier, Jean Baptiste Balquet, Marie-Hélène Wahl, Denis Lidove, Olivier Espitia, Olivier Cohen, Ariel Fain, Olivier Hachulla, Eric Mekinian, Arsène Rivière, Sébastien |
| description | Background and aimsSystemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments.MethodsWe used data from a national multicentric prospective study using the French SSc national database. We estimated the average treatment effect (ATE) of sildenafil, bosentan, angiotensin-converting enzyme (ACE) inhibitors and iloprost on diastolic dysfunction, altered ejection fraction |
| doi_str_mv | 10.1136/rmdopen-2024-004918 |
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Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments.MethodsWe used data from a national multicentric prospective study using the French SSc national database. We estimated the average treatment effect (ATE) of sildenafil, bosentan, angiotensin-converting enzyme (ACE) inhibitors and iloprost on diastolic dysfunction, altered ejection fraction <50% and pulmonary arterial hypertension (PAH) using a causal method, namely the longitudinal targeted minimum loss-based estimation, to adjust for confounding and informative censoring.ResultsWe included 1048 patients with available data regarding treatment. Regarding sildenafil analyses, the ATE on diastolic dysfunction at 3 years was −2.83% (95% CI −4.06; −1.60, p<0.00001), and the estimated ATE on altered ejection fraction <50% was −0.88% (95% CI −1.70; −0.05, p=0.037). We did not find a significative effect on PAH. Regarding bosentan, ACE inhibitors and iloprost, none of them neither showed a significant effect on diastolic dysfunction, altered ejection fraction <50% or PAH.ConclusionsUsing causal methods, our study is the first and largest suggesting that sildenafil might have benefits among SSc patients regarding diastolic dysfunction and altered ejection fraction occurrence. However, further studies assessing the effect of vasodilators on heart-related outcome among SSc patients are needed to confirm those exploratory results.</description><identifier>ISSN: 2056-5933</identifier><identifier>EISSN: 2056-5933</identifier><identifier>DOI: 10.1136/rmdopen-2024-004918</identifier><identifier>PMID: 39658051</identifier><language>eng</language><publisher>England: EULAR</publisher><subject>Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Body mass index ; Bosentan - therapeutic use ; Cardiovascular disease ; Cardiovascular Diseases ; Coronary vessels ; Ejection fraction ; Enzymes ; Female ; Heart attacks ; Humans ; Iloprost - therapeutic use ; Ischemia ; Kinases ; Life Sciences ; Machine Learning ; Male ; Middle Aged ; Mortality ; Original Research ; Patients ; Peptides ; Prospective Studies ; Pulmonary hypertension ; Risk factors ; RNA polymerase ; Scleroderma ; Scleroderma, Systemic - complications ; Scleroderma, Systemic - drug therapy ; Sildenafil Citrate - therapeutic use ; Skin ; Stroke Volume - drug effects ; Systemic Sclerosis ; Treatment Outcome ; Ulcers ; Vasodilator Agents - therapeutic use ; Vein & artery diseases</subject><ispartof>Rheumatic & musculoskeletal diseases open, 2024-12, Vol.10 (4), p.e004918</ispartof><rights>Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2024 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><rights>Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b454t-14a4204640666db5a9522fade6a1f9ceec28b0a16df1d6c307415782092f30d33</cites><orcidid>0000-0001-7229-3808 ; 0000-0001-7432-847X ; 0000-0003-2849-3049 ; 0000-0002-6149-0002 ; 0000-0002-5591-0955 ; 0000-0003-0821-9990</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://rmdopen.bmj.com/content/10/4/e004918.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://rmdopen.bmj.com/content/10/4/e004918.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,27903,27904,53769,53771,55328,77406,77432</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39658051$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-lille.fr/hal-04872491$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Guédon, Alexis F</creatorcontrib><creatorcontrib>Carrat, Fabrice</creatorcontrib><creatorcontrib>Mouthon, Luc</creatorcontrib><creatorcontrib>Launay, David</creatorcontrib><creatorcontrib>Chaigne, Benjamin</creatorcontrib><creatorcontrib>Pugnet, Grégory</creatorcontrib><creatorcontrib>Lega, Jean-Christophe</creatorcontrib><creatorcontrib>Hot, Arnaud</creatorcontrib><creatorcontrib>Cottin, Vincent</creatorcontrib><creatorcontrib>Agard, Christian</creatorcontrib><creatorcontrib>Allanore, Yannick</creatorcontrib><creatorcontrib>Fauchais, Anne Laure</creatorcontrib><creatorcontrib>Lescoat, Alain</creatorcontrib><creatorcontrib>Dhote, Robin</creatorcontrib><creatorcontrib>Papo, Thomas</creatorcontrib><creatorcontrib>Chatelus, Emmanuel</creatorcontrib><creatorcontrib>Bonnotte, Bernard</creatorcontrib><creatorcontrib>Kahn, Jean-Emmanuel</creatorcontrib><creatorcontrib>Diot, Elisabeth</creatorcontrib><creatorcontrib>Aouba, Achille</creatorcontrib><creatorcontrib>Magy-Bertrand, Nadine</creatorcontrib><creatorcontrib>Queyrel, Viviane</creatorcontrib><creatorcontrib>Le Quellec, Alain</creatorcontrib><creatorcontrib>Kieffer, Pierre</creatorcontrib><creatorcontrib>Amoura, Zahir</creatorcontrib><creatorcontrib>Granel, Brigitte</creatorcontrib><creatorcontrib>Gaultier, Jean Baptiste</creatorcontrib><creatorcontrib>Balquet, Marie-Hélène</creatorcontrib><creatorcontrib>Wahl, Denis</creatorcontrib><creatorcontrib>Lidove, Olivier</creatorcontrib><creatorcontrib>Espitia, Olivier</creatorcontrib><creatorcontrib>Cohen, Ariel</creatorcontrib><creatorcontrib>Fain, Olivier</creatorcontrib><creatorcontrib>Hachulla, Eric</creatorcontrib><creatorcontrib>Mekinian, Arsène</creatorcontrib><creatorcontrib>Rivière, Sébastien</creatorcontrib><title>Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis</title><title>Rheumatic & musculoskeletal diseases open</title><addtitle>RMD Open</addtitle><addtitle>RMD Open</addtitle><description>Background and aimsSystemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments.MethodsWe used data from a national multicentric prospective study using the French SSc national database. We estimated the average treatment effect (ATE) of sildenafil, bosentan, angiotensin-converting enzyme (ACE) inhibitors and iloprost on diastolic dysfunction, altered ejection fraction <50% and pulmonary arterial hypertension (PAH) using a causal method, namely the longitudinal targeted minimum loss-based estimation, to adjust for confounding and informative censoring.ResultsWe included 1048 patients with available data regarding treatment. Regarding sildenafil analyses, the ATE on diastolic dysfunction at 3 years was −2.83% (95% CI −4.06; −1.60, p<0.00001), and the estimated ATE on altered ejection fraction <50% was −0.88% (95% CI −1.70; −0.05, p=0.037). We did not find a significative effect on PAH. Regarding bosentan, ACE inhibitors and iloprost, none of them neither showed a significant effect on diastolic dysfunction, altered ejection fraction <50% or PAH.ConclusionsUsing causal methods, our study is the first and largest suggesting that sildenafil might have benefits among SSc patients regarding diastolic dysfunction and altered ejection fraction occurrence. However, further studies assessing the effect of vasodilators on heart-related outcome among SSc patients are needed to confirm those exploratory results.</description><subject>Adult</subject><subject>Aged</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Body mass index</subject><subject>Bosentan - therapeutic use</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases</subject><subject>Coronary vessels</subject><subject>Ejection fraction</subject><subject>Enzymes</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Iloprost - therapeutic use</subject><subject>Ischemia</subject><subject>Kinases</subject><subject>Life Sciences</subject><subject>Machine Learning</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original Research</subject><subject>Patients</subject><subject>Peptides</subject><subject>Prospective Studies</subject><subject>Pulmonary hypertension</subject><subject>Risk factors</subject><subject>RNA polymerase</subject><subject>Scleroderma</subject><subject>Scleroderma, Systemic - complications</subject><subject>Scleroderma, Systemic - drug therapy</subject><subject>Sildenafil Citrate - therapeutic use</subject><subject>Skin</subject><subject>Stroke Volume - drug effects</subject><subject>Systemic Sclerosis</subject><subject>Treatment Outcome</subject><subject>Ulcers</subject><subject>Vasodilator Agents - therapeutic use</subject><subject>Vein & artery diseases</subject><issn>2056-5933</issn><issn>2056-5933</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNp9Uk1v1DAQjRCIVqW_AAlF4gKHtOPPOFxQVQGttBIX4MLBcuzJblZJvNhJ1f33OM3SrwMn22_evJnxvCx7S-CMECbPQ-_8DoeCAuUFAK-IepEdUxCyEBVjLx_dj7LTGLcAQDhjJWGvsyNWSaFAkOPs9y8TvWs7M_qQuzCtY24Gl2_QhLEImHB0uZ9G63uMeTvkcR9H7FubR9th8LGNn1JGjre7zodZZZ-eptunwJvsVWO6iKeH8yT7-fXLj8urYvX92_XlxaqoueBjQbjhFLjkIKV0tTCVoLQxDqUhTWURLVU1GCJdQ5y0DEpORKkoVLRh4Bg7ya4XXefNVu9C25uw1960-g7wYa3TNG3qV5fQoFBY2zQ9r7lUzonKMXTWpsJ1k7Q-L1q7qe4TjMMYTPdE9GlkaDd67W80IZJWQGhS-LgobJ7lXV2s9IwBVyVNC7shifvhUC34PxPGUfdttNh1ZkA_Rc0Il5LO4ybq-2fUrZ9C-uk7VllSpYhILLawbFpNDNjcd0BAz8bRB-Po2Th6MU7Kevd46PucfzZJhPOFUPfbh7r_k_wLng7QOg</recordid><startdate>20241209</startdate><enddate>20241209</enddate><creator>Guédon, Alexis F</creator><creator>Carrat, Fabrice</creator><creator>Mouthon, Luc</creator><creator>Launay, David</creator><creator>Chaigne, Benjamin</creator><creator>Pugnet, Grégory</creator><creator>Lega, Jean-Christophe</creator><creator>Hot, Arnaud</creator><creator>Cottin, Vincent</creator><creator>Agard, Christian</creator><creator>Allanore, Yannick</creator><creator>Fauchais, Anne Laure</creator><creator>Lescoat, Alain</creator><creator>Dhote, Robin</creator><creator>Papo, Thomas</creator><creator>Chatelus, Emmanuel</creator><creator>Bonnotte, Bernard</creator><creator>Kahn, Jean-Emmanuel</creator><creator>Diot, Elisabeth</creator><creator>Aouba, Achille</creator><creator>Magy-Bertrand, Nadine</creator><creator>Queyrel, Viviane</creator><creator>Le Quellec, Alain</creator><creator>Kieffer, Pierre</creator><creator>Amoura, Zahir</creator><creator>Granel, Brigitte</creator><creator>Gaultier, Jean Baptiste</creator><creator>Balquet, Marie-Hélène</creator><creator>Wahl, Denis</creator><creator>Lidove, Olivier</creator><creator>Espitia, Olivier</creator><creator>Cohen, Ariel</creator><creator>Fain, Olivier</creator><creator>Hachulla, Eric</creator><creator>Mekinian, Arsène</creator><creator>Rivière, Sébastien</creator><general>EULAR</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-7229-3808</orcidid><orcidid>https://orcid.org/0000-0001-7432-847X</orcidid><orcidid>https://orcid.org/0000-0003-2849-3049</orcidid><orcidid>https://orcid.org/0000-0002-6149-0002</orcidid><orcidid>https://orcid.org/0000-0002-5591-0955</orcidid><orcidid>https://orcid.org/0000-0003-0821-9990</orcidid></search><sort><creationdate>20241209</creationdate><title>Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis</title><author>Guédon, Alexis F ; Carrat, Fabrice ; Mouthon, Luc ; Launay, David ; Chaigne, Benjamin ; Pugnet, Grégory ; Lega, Jean-Christophe ; Hot, Arnaud ; Cottin, Vincent ; Agard, Christian ; Allanore, Yannick ; Fauchais, Anne Laure ; Lescoat, Alain ; Dhote, Robin ; Papo, Thomas ; Chatelus, Emmanuel ; Bonnotte, Bernard ; Kahn, Jean-Emmanuel ; Diot, Elisabeth ; Aouba, Achille ; Magy-Bertrand, Nadine ; Queyrel, Viviane ; Le Quellec, Alain ; Kieffer, Pierre ; Amoura, Zahir ; Granel, Brigitte ; Gaultier, Jean Baptiste ; Balquet, Marie-Hélène ; Wahl, Denis ; Lidove, Olivier ; Espitia, Olivier ; Cohen, Ariel ; Fain, Olivier ; Hachulla, Eric ; Mekinian, Arsène ; Rivière, Sébastien</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b454t-14a4204640666db5a9522fade6a1f9ceec28b0a16df1d6c307415782092f30d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Body mass index</topic><topic>Bosentan - therapeutic use</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases</topic><topic>Coronary vessels</topic><topic>Ejection fraction</topic><topic>Enzymes</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Iloprost - therapeutic use</topic><topic>Ischemia</topic><topic>Kinases</topic><topic>Life Sciences</topic><topic>Machine Learning</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original Research</topic><topic>Patients</topic><topic>Peptides</topic><topic>Prospective Studies</topic><topic>Pulmonary hypertension</topic><topic>Risk factors</topic><topic>RNA polymerase</topic><topic>Scleroderma</topic><topic>Scleroderma, Systemic - complications</topic><topic>Scleroderma, Systemic - drug therapy</topic><topic>Sildenafil Citrate - therapeutic use</topic><topic>Skin</topic><topic>Stroke Volume - drug effects</topic><topic>Systemic Sclerosis</topic><topic>Treatment Outcome</topic><topic>Ulcers</topic><topic>Vasodilator Agents - therapeutic use</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guédon, Alexis F</creatorcontrib><creatorcontrib>Carrat, Fabrice</creatorcontrib><creatorcontrib>Mouthon, Luc</creatorcontrib><creatorcontrib>Launay, David</creatorcontrib><creatorcontrib>Chaigne, Benjamin</creatorcontrib><creatorcontrib>Pugnet, Grégory</creatorcontrib><creatorcontrib>Lega, Jean-Christophe</creatorcontrib><creatorcontrib>Hot, Arnaud</creatorcontrib><creatorcontrib>Cottin, Vincent</creatorcontrib><creatorcontrib>Agard, Christian</creatorcontrib><creatorcontrib>Allanore, Yannick</creatorcontrib><creatorcontrib>Fauchais, Anne Laure</creatorcontrib><creatorcontrib>Lescoat, Alain</creatorcontrib><creatorcontrib>Dhote, Robin</creatorcontrib><creatorcontrib>Papo, Thomas</creatorcontrib><creatorcontrib>Chatelus, Emmanuel</creatorcontrib><creatorcontrib>Bonnotte, Bernard</creatorcontrib><creatorcontrib>Kahn, Jean-Emmanuel</creatorcontrib><creatorcontrib>Diot, Elisabeth</creatorcontrib><creatorcontrib>Aouba, Achille</creatorcontrib><creatorcontrib>Magy-Bertrand, Nadine</creatorcontrib><creatorcontrib>Queyrel, Viviane</creatorcontrib><creatorcontrib>Le Quellec, Alain</creatorcontrib><creatorcontrib>Kieffer, Pierre</creatorcontrib><creatorcontrib>Amoura, Zahir</creatorcontrib><creatorcontrib>Granel, Brigitte</creatorcontrib><creatorcontrib>Gaultier, Jean Baptiste</creatorcontrib><creatorcontrib>Balquet, Marie-Hélène</creatorcontrib><creatorcontrib>Wahl, Denis</creatorcontrib><creatorcontrib>Lidove, Olivier</creatorcontrib><creatorcontrib>Espitia, Olivier</creatorcontrib><creatorcontrib>Cohen, Ariel</creatorcontrib><creatorcontrib>Fain, Olivier</creatorcontrib><creatorcontrib>Hachulla, Eric</creatorcontrib><creatorcontrib>Mekinian, Arsène</creatorcontrib><creatorcontrib>Rivière, Sébastien</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Rheumatic & musculoskeletal diseases open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guédon, Alexis F</au><au>Carrat, Fabrice</au><au>Mouthon, Luc</au><au>Launay, David</au><au>Chaigne, Benjamin</au><au>Pugnet, Grégory</au><au>Lega, Jean-Christophe</au><au>Hot, Arnaud</au><au>Cottin, Vincent</au><au>Agard, Christian</au><au>Allanore, Yannick</au><au>Fauchais, Anne Laure</au><au>Lescoat, Alain</au><au>Dhote, Robin</au><au>Papo, Thomas</au><au>Chatelus, Emmanuel</au><au>Bonnotte, Bernard</au><au>Kahn, Jean-Emmanuel</au><au>Diot, Elisabeth</au><au>Aouba, Achille</au><au>Magy-Bertrand, Nadine</au><au>Queyrel, Viviane</au><au>Le Quellec, Alain</au><au>Kieffer, Pierre</au><au>Amoura, Zahir</au><au>Granel, Brigitte</au><au>Gaultier, Jean Baptiste</au><au>Balquet, Marie-Hélène</au><au>Wahl, Denis</au><au>Lidove, Olivier</au><au>Espitia, Olivier</au><au>Cohen, Ariel</au><au>Fain, Olivier</au><au>Hachulla, Eric</au><au>Mekinian, Arsène</au><au>Rivière, Sébastien</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis</atitle><jtitle>Rheumatic & musculoskeletal diseases open</jtitle><stitle>RMD Open</stitle><addtitle>RMD Open</addtitle><date>2024-12-09</date><risdate>2024</risdate><volume>10</volume><issue>4</issue><spage>e004918</spage><pages>e004918-</pages><issn>2056-5933</issn><eissn>2056-5933</eissn><abstract>Background and aimsSystemic sclerosis (SSc) is an autoimmune connective disease characterised by excessive extracellular matrix deposition and widespread skin and internal organ fibrosis including various cardiac manifestations. Heart involvement is one of the leading causes of death among patients with SSc. In this study, we aimed to assess the effect of various vasodilator treatments.MethodsWe used data from a national multicentric prospective study using the French SSc national database. We estimated the average treatment effect (ATE) of sildenafil, bosentan, angiotensin-converting enzyme (ACE) inhibitors and iloprost on diastolic dysfunction, altered ejection fraction <50% and pulmonary arterial hypertension (PAH) using a causal method, namely the longitudinal targeted minimum loss-based estimation, to adjust for confounding and informative censoring.ResultsWe included 1048 patients with available data regarding treatment. Regarding sildenafil analyses, the ATE on diastolic dysfunction at 3 years was −2.83% (95% CI −4.06; −1.60, p<0.00001), and the estimated ATE on altered ejection fraction <50% was −0.88% (95% CI −1.70; −0.05, p=0.037). We did not find a significative effect on PAH. Regarding bosentan, ACE inhibitors and iloprost, none of them neither showed a significant effect on diastolic dysfunction, altered ejection fraction <50% or PAH.ConclusionsUsing causal methods, our study is the first and largest suggesting that sildenafil might have benefits among SSc patients regarding diastolic dysfunction and altered ejection fraction occurrence. However, further studies assessing the effect of vasodilators on heart-related outcome among SSc patients are needed to confirm those exploratory results.</abstract><cop>England</cop><pub>EULAR</pub><pmid>39658051</pmid><doi>10.1136/rmdopen-2024-004918</doi><orcidid>https://orcid.org/0000-0001-7229-3808</orcidid><orcidid>https://orcid.org/0000-0001-7432-847X</orcidid><orcidid>https://orcid.org/0000-0003-2849-3049</orcidid><orcidid>https://orcid.org/0000-0002-6149-0002</orcidid><orcidid>https://orcid.org/0000-0002-5591-0955</orcidid><orcidid>https://orcid.org/0000-0003-0821-9990</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2056-5933 |
| ispartof | Rheumatic & musculoskeletal diseases open, 2024-12, Vol.10 (4), p.e004918 |
| issn | 2056-5933 2056-5933 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11629012 |
| source | BMJ Open Access Journals; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access |
| subjects | Adult Aged Angiotensin-Converting Enzyme Inhibitors - therapeutic use Body mass index Bosentan - therapeutic use Cardiovascular disease Cardiovascular Diseases Coronary vessels Ejection fraction Enzymes Female Heart attacks Humans Iloprost - therapeutic use Ischemia Kinases Life Sciences Machine Learning Male Middle Aged Mortality Original Research Patients Peptides Prospective Studies Pulmonary hypertension Risk factors RNA polymerase Scleroderma Scleroderma, Systemic - complications Scleroderma, Systemic - drug therapy Sildenafil Citrate - therapeutic use Skin Stroke Volume - drug effects Systemic Sclerosis Treatment Outcome Ulcers Vasodilator Agents - therapeutic use Vein & artery diseases |
| title | Vasodilator drugs and heart-related outcomes in systemic sclerosis: an exploratory analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T23%3A25%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Vasodilator%20drugs%20and%20heart-related%20outcomes%20in%20systemic%20sclerosis:%20an%20exploratory%20analysis&rft.jtitle=Rheumatic%20&%20musculoskeletal%20diseases%20open&rft.au=Gu%C3%A9don,%20Alexis%20F&rft.date=2024-12-09&rft.volume=10&rft.issue=4&rft.spage=e004918&rft.pages=e004918-&rft.issn=2056-5933&rft.eissn=2056-5933&rft_id=info:doi/10.1136/rmdopen-2024-004918&rft_dat=%3Cproquest_doaj_%3E3147728815%3C/proquest_doaj_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3147728815&rft_id=info:pmid/39658051&rft_doaj_id=oai_doaj_org_article_70fe58ebc8054b468dd59d3edccb5abf&rfr_iscdi=true |