Effectiveness of bosentan in the treatment of systemic sclerosis‑related digital ulcers: Systematic review and meta‑analysis

The aim of the present systematic review and meta‑analysis was to evaluate the therapeutic efficacy of bosentan, a dual endothelin receptor antagonist, for systemic sclerosis (SSc) patients with digital ulcers (DUs).

A systematic search of MEDLINE, Embase, Web of Science, and Scopus was done using appropriate keywords till September 2021. Weighted mean difference (WMD) as the effect of therapeutic efficacy of bosentan on continuous outcomes was an estimate. Furthermore, the pooled prevalence of diffuse SSc and limited SSc was computed. Fixed or random effects models when appropriate were used for data synthesis.

Totally, 469 patients, with a mean age ranging from 48.1 to 63.7 years, from 8 studies were included in the systematic review and meta‑analysis. The pooled frequency of diffuse SSc and limited SSc was 56% (95% confidence interval [CI]: 39%, 73%) and 44% (95% CI: 27%, 61%). The pooled prevalence of new DUs following bosentan treatment was 21% (95% CI: 10%, 33%). The results of the meta‑analysis showed a pooled mean decrease of WMD: −0.09 (95% CI: −0.020, 0.02, P = 0.10), WMD: −2.82 (95% CI: −5.91, 0.27, P = 0.07), and WMD: −6.65 (95% CI: −9.49, −3.82, P < 0.001) in mean SSc‑Health Assessment Questionnaire, pain, and Rodnan score, respectively. Our meta‑analysis also indicated a significant pooled decrease in the number of new DUs in SSc patients compared to placebo subjects (WMD: −0.89 [95% CI: −1.40, −0.37; P = 0.001]) and baseline values (WMD: −1.34 (95% CI: −1.95, −0.73; P < 0.001).

Bosentan possibly is an efficacious treatment option for SSc‑related DUs. Although further large‑scale randomized clinical trials are required to confirm the preliminary finding and underlying mechanisms of action.