The aim of the present study was to retrospectively evaluate response to
therapy in 73 patients affected by
systemic sclerosis (SSc) who underwent long-term cyclic treatment with intravenous
iloprost for peripheral vascular involvement (average
duration of treatment 54.12±41.04 months). Seventy-three SSc patients were enrolled. Data were collected by reviewing clinical records and by phone or direct interview. Patients underwent a thorough physical examination at the end of follow up. The incidence of severe vascular manifestations was also assessed. Statistical analysis was performed by Wilcoxon's signed rank test and descriptive statistics using Statview software. In this study cohort, 55 of 73 (75.2%) patients had a history of ischemic
digital ulcers (DUs); 28 patients (38.4%) had active DUs at the beginning of treatment.
Skin ulcers healed completely in 25 of 28 patients (89.3%) at the end of the first treatment. However, 40 of 55 patients (72.6%) relapsed after an average of 24 months. There was a significant correlation between relapse rate and/or number of
ulcers and clinical factors (diffuse subset, changes in results of Allen's test, NT-pro BNP levels). The annual incidence of
pulmonary arterial hypertension (PAH) was 2.34 (95%CI: 0.94-4.83) per 100 person years, the rate of
gangrene was 2.7%, and no cases of scleroderma renal crisis were recorded. The incidence of PAH and of digital
gangrene was higher than that observed in unselected SSc case series. These data suggest that our patients treated with
iloprost have a higher vascular involvement than large case series of unselected SSc patients. A number of clinical factors are correlated to the severity of vascular involvement and could have an impact on the response to
therapy. The clinical significance of these findings requires clarification and further investigation is needed.