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[Prostaglandin E1 in stage III and IV arterial occlusive diseases. results of a multicenter study]
Insights
Prostaglandin E1 (PGE1) and adenosine triphosphate (ATP) improved chronic arterial occlusive disease symptoms. PGE1 demonstrated superior efficacy in pain reduction, ulcer healing, and preventing amputations compared to ATP.
Area of Science:
- Vascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Advanced chronic arterial occlusive disease presents significant challenges in pain management and limb salvage.
- Current treatment options for severe arterial disease often have limitations and side effects.
Purpose of the Study:
- To compare the efficacy and safety of intraarterial prostaglandin E1 (PGE1) versus adenosine triphosphate (ATP) in patients with advanced chronic arterial occlusive disease.
Main Methods:
- A controlled randomized trial involving 57 patients across four centers.
- Patients received either PGE1 (20 micrograms daily) or ATP (30 mg daily) intraarterially for three weeks.
- Outcomes assessed included pain reduction, analgesic use, ulcer healing, stage improvement, amputation rates, and side effects.
Main Results:
- Both PGE1 and ATP significantly reduced resting pain, with PGE1 showing better results in stage III disease.
- PGE1 led to a significantly greater reduction in analgesic use and superior healing or improvement of ulcers.
- Amputation rates were significantly lower in the PGE1 group (3 vs. 9 in ATP group).
- PGE1 had more reported side effects (reddening, pain, swelling) than ATP.
Conclusions:
- Prostaglandin E1 (PGE1) appears to be a more effective treatment than adenosine triphosphate (ATP) for advanced chronic arterial occlusive disease, particularly in improving pain, healing ulcers, and reducing amputations.
- While PGE1 showed a higher incidence of local side effects, its overall clinical benefit was deemed significantly more favorable.
Abstract:
In a controlled randomized trial at four centers, using a common protocol, 57 patients with advanced chronic arterial occlusive disease (21 in stage III, 36 in stage IV) were treated with prostaglandin E1 (PGE1) or adenosine triphosphate (ATP) for three weeks. Both substances were administered intraarterially over 60 min. Daily dose of PGE1 was 20 micrograms, of ATP 30 mg. Both produced a significant reduction in resting pain at the end of the treatment phase, in stage III significantly better with PGE1. There was also a clear reduction in the use of analgesics, significantly more so with PGE1. Healing or improvement of ulcers was significantly better with PGE1, while there was no significant differences between the two drugs as regards stage improvement. Three amputations had to be performed in the PGE1 group, nine in the ATP group, a significant difference. Side effects in the form of reddening, pain and swellings occurred in 15 patients of the PGE1 group and six of the ATP group. Final verdict by the treating doctor about the success of treatment was significantly more favorable for PGE1.