Pentoxifylline for intermittent claudication

Area of Science:

• Vascular Medicine
• Pharmacology
• Clinical Trials

Background:

• Intermittent claudication (IC) is a symptom of peripheral arterial disease (PAD), linked to significant morbidity and mortality.
• Pentoxifylline is a drug used to treat IC by improving blood flow and tissue oxygenation.
• Previous studies on pentoxifylline's efficacy in PAD have yielded variable results.

Purpose of the Study:

• To evaluate the effectiveness of pentoxifylline in enhancing walking capacity for individuals with stable intermittent claudication (Fontaine stage II).
• To assess improvements in pain-free walking distance (PFWD) and total walking distance (TWD).

Main Methods:

• A systematic review and update of double-blind, randomized controlled trials (RCTs) comparing pentoxifylline with placebo or other pharmacological interventions.
• Searched multiple databases including Cochrane Vascular, CENTRAL, MEDLINE, Embase, CINAHL, and clinical trial registries up to January 2020.
• Assessed study quality using the Cochrane 'Risk of bias' tool and GRADE criteria; data on PFWD, TWD, ABI, QoL, and side effects were collected.

Main Results:

• The review included 24 studies with 3377 participants; 17 compared pentoxifylline to placebo.
• Low-certainty evidence suggests pentoxifylline may improve PFWD and TWD compared to placebo, with wide-ranging percentage improvements.
• No significant difference was found in ankle-brachial pressure index (ABI) or quality of life (QoL) between groups; pentoxifylline was generally well-tolerated with gastrointestinal side effects reported.

Conclusions:

• High-certainty evidence for pentoxifylline's effects in IC is lacking.
• The role of pentoxifylline for IC Fontaine class II remains uncertain due to significant heterogeneity and low to moderate certainty of evidence.
• Pentoxifylline demonstrated potential benefits in walking distance but not in ABI or QoL, with generally good tolerability.