PMID- 32414728
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20240426
IS  - 1473-4893 (Electronic)
IS  - 1470-2118 (Print)
IS  - 1470-2118 (Linking)
VI  - 20
IP  - 3
DP  - 2020 May
TI  - Differing commissioning arrangements may contribute to geographic variation in 
      clinical management of digital ulcers in systemic sclerosis.
PG  - 343-345
LID - 10.7861/clinmed.2020-0031 [doi]
AB  - Phosphodiesterase inhibitors (such as sildenafil) and endothelin receptor 
      antagonist, bosentan, are effective for digital ulcer disease in systemic 
      sclerosis (SSc-DU) and are endorsed in international treatment recommendations. 
      Commissioning of high-cost drugs, such as bosentan, however, differs across 
      devolved nations of the UK. We report a multicentre service evaluation project to 
      examine 'real world' management of SSc-DU before and following the 2015 UK 
      Scleroderma Study Group (UKSSG) guidance, across south-west (SW) England and 
      Wales. Results showed that iloprost and sildenafil use for SSc-DU was higher in 
      patients in Wales prior to 2015. Between 2015-2017, sildenafil use for SSc-DU 
      increased in SW England while remaining stable in Wales. Bosentan use for SSc-DU 
      after 2015 in SW England increased, while remaining stable and proportionately 
      lower in Wales. These findings demonstrate that differing commissioning guidance 
      across devolved nations of the UK seems to contribute to geographic variation in 
      patient care.
CI  - (c) Royal College of Physicians 2020. All rights reserved.
FAU - Reilly, Elizabeth
AU  - Reilly E
AD  - Royal National Hospital for Rheumatic Diseases, Bath, UK and University of Bath, 
      Bath, UK elizabethreilly2@nhs.net.
FAU - Alshakh, Randa
AU  - Alshakh R
AD  - Bristol Royal Infirmary, Bristol, UK.
FAU - Beynon, Celia
AU  - Beynon C
AD  - University Hospital of Wales, Cardiff, UK.
FAU - Cates, Matthew
AU  - Cates M
AD  - Torbay Hospital, Lowes Bridge, Torquay, UK.
FAU - Das, Dhivya
AU  - Das D
AD  - Wrexham Maelor Hospital, Wrexham, UK.
FAU - Majeed, Shuja
AU  - Majeed S
AD  - Great Western Hospital, Swindon, UK.
FAU - Memon, Ahsan
AU  - Memon A
AD  - Royal Devon and Exeter Hospital, Exeter, UK.
FAU - O'Beirn, Patrick
AU  - O'Beirn P
AD  - University Hospital of Wales, Cardiff, UK.
FAU - Ritchie, James
AU  - Ritchie J
AD  - Weston General Hospital, Weston-super-Mare, UK.
FAU - Pauling, John D
AU  - Pauling JD
AD  - Royal National Hospital for Rheumatic Diseases, Bath, UK and University of Bath, 
      Bath, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Clin Med (Lond)
JT  - Clinical medicine (London, England)
JID - 101092853
RN  - 0 (Sulfonamides)
SB  - IM
MH  - England
MH  - Fingers
MH  - Humans
MH  - *Scleroderma, Systemic/complications/epidemiology
MH  - *Skin Ulcer
MH  - Sulfonamides
MH  - Treatment Outcome
MH  - Ulcer
MH  - Wales
PMC - PMC7354016
OTO - NOTNLM
OT  - Systemic sclerosis
OT  - digital ulcer
OT  - endothelin receptor antagonist
OT  - phosphodiesterase inhibitors
OT  - scleroderma
EDAT- 2020/05/18 06:00
MHDA- 2021/05/15 06:00
PMCR- 2020/05/01
CRDT- 2020/05/17 06:00
PHST- 2020/05/17 06:00 [entrez]
PHST- 2020/05/18 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/05/01 00:00 [pmc-release]
AID - S1470-2118(24)03592-9 [pii]
AID - clinmedicine [pii]
AID - 10.7861/clinmed.2020-0031 [doi]
PST - ppublish
SO  - Clin Med (Lond). 2020 May;20(3):343-345. doi: 10.7861/clinmed.2020-0031.