 |
|
Treatment of Systemic Sclerosis With Extracorporeal PhotochemotherapyResults of a Multicenter Trial
Alain H. Rook, MD;
Bruce Freundlich, MD;
Brian V. Jegasothy, MD;
Maritza I. Perez, MD;
Walter G. Barr, MD;
Sergio A. Jimenez, MD;
Robert L. Rietschel, MD;
Bruce Wintroub, MD;
M. Bashar Kahaleh, MD;
John Varga, MD;
Peter W. Heald, MD;
Virginia Steen, MD;
Mary C. Massa, MD;
George F. Murphy, MD;
Charles Perniciaro, MD;
Michael Istfan, MD;
Samir K. Ballas, MD;
Richard L. Edelson, MD
Arch Dermatol. 1992;128(3):337-346.
Abstract
| |
• Background and Design.—
In a pilot study of extracorporeal photochemotherapy, two patients with systemic sclerosis who received this therapy experienced significant clinical improvement. These results prompted the development of a multicenter trial to examine the benefit of extracorporeal photochemotherapy in the treatment of systemic sclerosis. Seventy-nine patients with systemic sclerosis of recent onset (mean symptom duration, 1.83 years) and progressive skin involvement during the preceding 6 months entered a randomized, parallel-group, single-blinded clinical trial comparing extracorporeal photochemotherapy treatments given on 2 consecutive days monthly with treatment with D-penicillamine at a maximum dose of 750 mg/d. Blinded clinical examiners evaluated skin severity score (thickness), percent surface area involvement, oral aperture, and hand closure. Serial skin biopsies and pulmonary function studies were also performed.
Results.—
Following 6 months of treatment, significant improvement in skin severity score occurred in 21 (68%) of 31 patients receiving photochemotherapy and in eight (32%) of 25 receiving D-penicillamine treatment, while significant worsening occurred in three (10%) of 31 receiving photochemotherapy and in eight (32%) of 25 receiving penicillamine treatment, thus indicating a significantly higher response rate for individuals who received photochemotherapy (P.02). At both the 6- and 10-month evaluation points, the mean skin severity score, mean percent skin involvement, and mean oral aperture measurements were significantly improved from baseline among those who received photochemotherapy. Mean right and left hand closure measurements had also improved significantly by 10 months of therapy. By comparison, among the patients treated with D-penicillamine, none of the parameters of cutaneous disease had improved significantly after 6 months of therapy, although for those individuals in whom treatment was continued, the mean skin severity score and mean percent skin involvement had improved by 10 months. Skin biopsy studies revealed a correlation between clinical improvement and decreased thickness of the dermal layer. Adverse effects of extracorporeal photochemotherapy were minimal and did not require discontinuation of treatment in any of the patients receiving this therapy; six patients permanently discontinued the use of D-pencillamine treatment due to adverse effects.
Conclusions.—
For patients with systemic sclerosis of recent onset, extracorporeal photochemotherapy is a well-tolerated treatment that may partially reverse the process that results in cutaneous sclerosis.
(Arch Dermatol. 1992;128:337-346)
Author Affiliations
| |
From the Departments of Dermatology (Drs Rook and Murphy) and Rheumatology (Dr Freundlich) and the General Clinical Research Center of the Hospital of the University of Pennsylvania, Philadelphia; Departments of Dermatology (Dr Jegasothy) and Rheumatology (Dr Steen), University of Pittsburgh (Pa) Medical Center; Department of Dermatology (Drs Perez, Heald, and Edelson) and the General Clinical Research Center of Yale University, New Haven, Conn; Departments of Rheumatology (Dr Barr) and Dermatology (Dr Massa), Loyola University, Maywood, Ill; Department of Rheumatology (Drs Jimenez and Varga) and the Blood Bank (Dr Ballas), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Dermatology, Ochsner Clinic, New Orleans, La (Drs Rietschel and Perniciaro); Department of Dermatology and the General Clinical Research Center, University of California at San Francisco (Dr Wintroub); and Department of Rheumatology (Drs Kahaleh and Istfan), Medical University of South Carolina, Charleston.
Footnotes
Accepted for publication October 4, 1991.
Presented in part at the Annual American Federation for Clinical Research Meeting, Washington, DC, May 6, 1990.
Reprint requests to Department of Dermatology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (Dr Rook).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Bronchiolitis obliterans following haematopoietic stem cell transplantation
Soubani and Uberti
Eur Respir J 2007;29:1007-1019.
ABSTRACT
| FULL TEXT
The role of DMARDs in systemic sclerosis therapy
Blank et al.
Rheumatology (Oxford) 2006;45:iii42-iii44.
ABSTRACT
| FULL TEXT
Treatment of Scleroderma
Sapadin and Fleischmajer
Arch Dermatol 2002;138:99-105.
ABSTRACT
| FULL TEXT
Identification of Clonal T Cells in the Blood of Patients With Systemic Sclerosis: Positive Correlation With Response to Photopheresis
French et al.
Arch Dermatol 2001;137:1309-1313.
ABSTRACT
| FULL TEXT
Photopheresis at onset of type 1 diabetes: a randomised, double blind, placebo controlled trial
Ludvigsson et al.
Arch. Dis. Child. 2001;85:149-154.
ABSTRACT
| FULL TEXT
Effects of the American College of Rheumatology systemic sclerosis trial guidelines on the nature of systemic sclerosis patients entering a clinical trial
Furst et al.
Rheumatology (Oxford) 2001;40:615-622.
ABSTRACT
| FULL TEXT
Photopheresis for the Prevention of Rejection in Cardiac Transplantation
Barr et al.
NEJM 1998;339:1744-1751.
ABSTRACT
| FULL TEXT
Psoralen Bath Plus UV-A Therapy: Possibilities and Limitations
Luftl et al.
Arch Dermatol 1997;133:1597-1603.
ABSTRACT
Is there a future for extracorporeal photochemotherapy in the treatment of the rheumatological diseases?
HOLBROOK and POWELL
Ann Rheum Dis 1997;56:339-340.
FULL TEXT
PUVA Bath Photochemotherapy for Localized Scleroderma: Evaluation of 17 Consecutive Patients
Kerscher et al.
Arch Dermatol 1996;132:1280-1282.
ABSTRACT
Photopheresis and Systemic Sclerosis
Zachariae et al.
Arch Dermatol 1992;128:1651-1652.
ABSTRACT
Dermatology
Dover and Arndt
JAMA 1992;268:342-344.
ABSTRACT
Photochemotherapy in Systemic Sclerosis: The Stage Is Set
Trentham
Arch Dermatol 1992;128:389-390.
ABSTRACT
|
