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. 2024 Jun 14;12(6):e5885.
doi: 10.1097/GOX.0000000000005885. eCollection 2024 Jun.

Toxin for Treating Raynaud Conditions in Hands (The TORCH Study): A Systematic Review and Meta-analysis

Ellen Geary  1   2 , Justin C R Wormald  3   4 , Kevin J Cronin  5 , Henk P Giele  4 , Laura Durcan  6 , Oran Kennedy  7   8 , Fergal O'Brien  7 , Roisin T Dolan  1   2
Affiliations

Toxin for Treating Raynaud Conditions in Hands (The TORCH Study): A Systematic Review and Meta-analysis

Ellen Geary et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Raynaud disease of the hands is a complex disorder resulting in inappropriate constriction and/or insufficient dilation in microcirculation. There is an emerging role for botulinum toxin type A (BTX-A) in the treatment armamentarium for refractory Raynaud disease. The aim of this systematic review was to critically evaluate the management of primary and secondary Raynaud disease treated with BTX-A intervention.

Methods: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of clinical studies assessing treatment of primary or secondary Raynaud disease with BTX-A by searching Ovid MEDLINE and Embase databases from inception to first August 2023. The review protocol was prospectively registered on the PROSPERO database (CRD42022312253).

Results: Our search strategy identified 288 research articles, of which 18 studies [four randomized controlled trials (RCTs), two non-RCTs, five case series, and seven retrospective cohort studies] were eligible for analysis. Meta-analysis demonstrated that the probability of pain visual analog scale score improvement with BTX-A intervention was 81.95% [95% confidence interval (74.12-87.81) P = 0.19, heterogeneity I 2 = 26%] and probability of digital ulcer healing was 79.37% [95% confidence interval (62.45-89.9) P = 0.02, heterogeneity I 2 = 56%].

Conclusions: Delivery of BTX-A to digital vessels in the hand may be an effective management strategy for primary and secondary Raynaud disease. A definitive, appropriately-powered RCT with objective functional and patient-reported outcome measures is required to accurately assess and quantify the efficacy of BTX-A in Raynaud disease of the hands.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart: breakdown of the articles analyzed for inclusion.
Fig. 2.
Fig. 2.
Meta-analysis: likelihood of improvement in VAS score.
Fig. 3.
Fig. 3.
Meta-analysis: likelihood of improvement in ulcer healing with the use of BTX-A.
See this image and copyright information in PMC

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