Botulinum Toxin for Refractory Digital Ischemia and Ulcers in Systemic Sclerosis: A Systematic Review and...

Area of Science:

• Vascular Medicine
• Dermatology
• Rheumatology

Background:

• Systemic sclerosis and other vasculopathies can cause debilitating digital ischemia, ulcers, and gangrene.
• Standard treatments often fail to resolve these severe complications.
• Botulinum toxin (BTX) is being explored as a potential therapeutic option.

Purpose of the Study:

• To assess the effectiveness and safety of BTX injections for digital ischemia, ulcers, and gangrene.
• To identify factors predicting treatment response.
• To conduct a systematic review and individual participant data (IPD) meta-analysis.

Main Methods:

• Searched MEDLINE, Embase, and Scopus databases up to April 2024.
• Included studies of patients with acute digital ischemia, ulcers, or gangrene.
• Extracted data and assessed study quality; performed Cox regression for outcome predictors.

Main Results:

• Analyzed data from 119 patients; BTX achieved high complete response rates for ischemia (93.1%), ulcers (90.1%), and gangrene (87.5%).
• Adverse events were infrequent, primarily transient muscle weakness and injection site pain.
• Autoimmune etiology and younger age correlated with faster response, but no factors reached statistical significance in multivariable models.

Conclusions:

• BTX injections represent a safe and effective adjunctive therapy for refractory digital ischemia in systemic sclerosis.
• High rates of healing and ischemia resolution were observed.
• Further prospective trials are recommended to confirm long-term efficacy and standardize treatment protocols.