Management Practices for Raynaud Phenomenon in Patients With Systemic Sclerosis: A Real-World Data From Community-Based Practices in the United States.

Abstract

Objective: To describe Raynaud phenomenon (RP) management practices for systemic sclerosis (SSc) patients among US community-based rheumatologists.

Methods: We identified all adult SSc patients, diagnosed by a rheumatologist, from the FORWARD Databank between 1999 and 2023. We evaluated longitudinal RP medication use, from data collected by semiannual questionnaires. We evaluated factors associated with RP medication use with multivariable Andersen and Gill Cox proportional models.

Results: Of the 270 SSc patients, 61% received a medication for RP over the median (interquartile range) follow-up of 3.4 (1.3-7.8) years. Calcium-channel blockers were the most chosen overall (48%) and first-line (75%) medication, followed by renin-angiotensin system inhibitors (18% [23%]). The use of RP medications persistently (29%), combination regimens (20%), and advanced therapies (15%; phosphodiesterase-5 inhibitors [PDE5i], endothelin receptor antagonists, or prostaglandin analogs) throughout the follow-up was low. Whereas calcium-channel blocker use has declined, PDE5i use has increased since 2019. Factors associated with initiating medications for RP were hypertension (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.25-1.98), pulmonary disease (HR, 1.25; 95% CI, 1.04-1.52), immunomodulatory use (HR, 1.32; 95% CI, 1.04-1.68), higher annual income (HR, 1.33; 95% CI, 1.02-1.73), and having an insurance (HR, 2.37; 95% CI, 1.04-5.44).

Conclusion: Overall use of RP medication was low with poor maintenance rates in less than one-third of the patients from this community sample. The pattern of RP medication use changed over time with increasing use of PDE5i use since 2019. Although socioeconomic factors had impact on RP medication initiation, there is also a need for education and guideline recommendations to assist community-based rheumatologists in RP management.