New treatment options in intermittent claudication: the US experience

The goals of treatment in intermittent claudication are to modify cardiovascular risk factors and to reduce claudication pain, increase walking distance and improve quality of life. Walking distance in intermittent claudication can be improved both by exercise rehabilitation and by pharmacological treatments. At present, the only two drugs licensed in the US for the treatment of claudication symptoms are oxpentifylline and cilostazol. Although oxpentifylline has been shown to increase maximal and pain-free walking distance in a number of trials, other studies call its efficacy into question. Eight double-blind, placebo-controlled trials have established that cilostazol improves both maximal and pain-free walking distance in patients with moderate to severe intermittent claudication, with highly statistically significant differences compared with placebo. Cilostazol has also been shown to improve the physical dimensions of quality of life. Naftidrofuryl is licensed for the treatment of intermittent claudication in Europe, but not in the US. Some clinical trials have shown it to be effective in treating intermittent claudication. Promising new agents in the treatment of intermittent claudication include L-arginine, propionyl-L-carnitine, prostaglandins, and angiogenic growth factors such as vascular endothelial growth factor and basic fibroblast growth factor.