Botulinum Toxin in the Treatment of Raynaud's - Full Text View

Purpose

The investigators are studying a medical condition known as Raynaud's Phenomenon (RP). RP is a painful condition in which cold surroundings or stressful events trigger pain, a cold sensation, and in severe cases, sores and ulcers on one's fingers. The investigators think that RP results from problems with some of the components of the blood vessels, surrounding nerves, and some of the circulating messengers in the bloodstream. Although there are many different medicines that are currently used to treat RP, the investigators have not yet found a cure for severe cases of this condition. Furthermore, the investigators have found few medicines that show consistent healing of the ulcers that may be associated with RP. Some of the treatments include medicines that are used to treat high blood pressure known as calcium channel blockers. Medications that thin the blood (anticoagulants) such as aspirin have also been used to treat RP.

In this study, the investigators will investigate a new treatment for RP known as Botulinum toxin A. Botulinum toxin is a chemical that is temporarily toxic to nerves, but has been approved by the government for the treatment of several other conditions including but not limited to: excessive sweating, neck pain associated with a condition known as cervical dystonia, uncontrollable forcible closure of the eyelids known as blepharospasm, and a condition known as strabismus in which the eyes are not in alignment with one another.

This study will aim to greatly improve the quality of life and pain associated with RP. Previous studies also support the chance that Botulinum toxin will help to heal some of the ulcers associated with RP. Although there is no current standard of care, many of the patients in the study will have already failed or are unable to tolerate commonly used treatments such as lifestyle modifications, calcium channel blockers, nitroglycerin, and anticoagulants. If the patient chooses to participate in the study, he/she will be randomly assigned to receive an injection with Botulinum toxin in either the left or right hand. The other hand will be injected with saline solution. Neither the patient nor the physician or research personnel seen in follow-up will know which hand is injected with Botulinum toxin.

Condition	Intervention
Raynaud's Syndrome	Drug: botulinum toxin A


Study Type:	Interventional
Study Design:	Intervention Model: Single Group Assignment Masking: Triple (Participant, Care Provider, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Botulinum Toxin in the Treatment of Raynaud's

Resource links provided by NLM:

MedlinePlus related topics: Botox Raynaud's Disease

Drug Information available for: OnabotulinumtoxinA

Genetic and Rare Diseases Information Center resources: Systemic Scleroderma

U.S. FDA Resources

Further study details as provided by Suephy Chen, MD, Emory University:

Primary Outcome Measures:

Mean Digital Temperature Difference From Baseline [ Time Frame: 6 weeks ]
Each digit temperature was measured and recorded at baseline, and then measured and re-recorded after 3 minute intervals following a 20 second 4 degree Celsius ice bath immersion.


Enrollment:	10
Study Start Date:	October 2010
Study Completion Date:	March 2012
Primary Completion Date:	October 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Placebo Comparator: Botox single-drug dosage comparison cross-over study	Drug: botulinum toxin A Botulinum toxin A will be injected into participants hand total 40units

Eligibility


Ages Eligible for Study:	18 Years to 89 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:Adult (>18 years) patients with severe RP of any etiology will be invited to participate. Inclusion criteria include a) history of digital infarcts or ulcerations, b) unresponsive to standard therapies, or c) impending potential for digital amputation. Patients on other standard therapies such as antiplatelet agents, vasodilators, and calcium channel blockers will be included. -

Exclusion Criteria:Pregnancy, mild disease, patients with myasthenia gravis, botulinum toxin allergy, and phobia of needles are exclusion criteria. Women of childbearing age will need to demonstrate a negative urine pregnancy test. Myasthenia gravis is excluded because underlying generalized weakness can be exacerbated, and local weakness at injection sites can occur more than otherwise expected.

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01233999

Locations


United States, Georgia
Emory University
Atlanta, Georgia, United States, 30322

Sponsors and Collaborators

Emory University

Investigators


Principal Investigator:	Suephy C Chen, MD	Emory University

More Information


Responsible Party:	Suephy Chen, MD, Associate Professor, Emory University
ClinicalTrials.gov Identifier:	NCT01233999 History of Changes
Other Study ID Numbers:	IRB00015510
Study First Received:	November 2, 2010
Results First Received:	July 17, 2013
Last Updated:	March 15, 2014

Keywords provided by Suephy Chen, MD, Emory University:


Scleroderma Raynaud's Syndrome

Additional relevant MeSH terms:


Raynaud Disease Peripheral Vascular Diseases Vascular Diseases Cardiovascular Diseases Botulinum Toxins Botulinum Toxins, Type A abobotulinumtoxinA onabotulinumtoxinA	Acetylcholine Release Inhibitors Membrane Transport Modulators Molecular Mechanisms of Pharmacological Action Cholinergic Agents Neurotransmitter Agents Physiological Effects of Drugs Neuromuscular Agents Peripheral Nervous System Agents

ClinicalTrials.gov processed this record on September 21, 2017