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Pharmacological management of intermittent claudication: a meta-analysis of randomised trials
1Thomas C. Chalmers Centre for Systematic Reviews, CHEO Research Institute, Ottawa, Ontario, Canada. dmoher@uottawa.ca
Insights
Medical therapies for intermittent claudication offer modest improvements in walking distance. Pentoxifylline showed better results than naftidrofuryl, but overall benefits were limited for patients with this condition.
Area of Science:
- Vascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Intermittent claudication, a symptom of atherosclerosis, significantly impairs mobility and quality of life.
- Current medical treatments include vasodilators, antiplatelet agents, and alternative therapies like ginkgo biloba.
Purpose of the Study:
- To conduct a meta-analysis of current medical therapies for intermittent claudication.
- To evaluate the efficacy of various treatments on walking distance and other clinical endpoints.
Main Methods:
- Meta-analysis of 52 trials involving 5088 patients.
- Assessment of primary endpoints: pain-free walking distance and maximum walking distance after 24 weeks.
Main Results:
- Vasodilators demonstrated the most significant improvements in walking distance.
- Pentoxifylline was more effective than naftidrofuryl, yielding modest benefits.
- Antiplatelets, ginkgo biloba, and levocarnitine showed slight, clinically limited improvements over placebo.
- Patients walked an average of 60m further, with approximately half of this distance being pain-free.
Conclusions:
- Some medical therapies, notably pentoxifylline, offer modest functional gains for moderate intermittent claudication.
- Limited data exists for other endpoints like mortality and adverse effects.
- Further research with standardized trial designs and a comparison with physical therapy is recommended.
Abstract:
Intermittent claudication, a symptom of atherosclerosis in the large vessels of the lower limbs, greatly affects patient mobility and quality of life. Medical therapy for a moderate form of this condition includes vasodilators, antiplatelet agents and alternative treatments such as ginkgo biloba.A meta-analysis of results from 52 trials (including 5088 patients) was conducted for all current medical therapies for intermittent claudication. After 24 weeks, some of the medical therapies were found to be more effective than placebo for the primary end-points of either pain-free walking distance or maximum walking distance. Vasodilators presented the best results in walking distance. Pentoxifylline offered better results than naftidrofuryl, although the treatment benefit, measured in additional metres walked with treatment than without, was modest. Antiplatelets, ginkgo biloba and levocarnitine were slightly more effective than placebo, although the treatment benefit was of limited clinical importance. On average, patients walked 60m further with therapy than without, and only about half of that added distance was pain-free. Very little consistent information was available for other clinical end-points, such as overall mortality and adverse effects. These data suggest that some of the medical therapy, pentoxifylline in particular, can only modestly increase functional status in patients with moderate intermittent claudication. There is a need for uniformity in research design and reporting of trials. A future trial comparing medical therapy with physical therapy is indicated.