Comparing interventions used to treat venous leg ulcers - A network meta-analysis

Area of Science:

• Vascular Medicine
• Dermatology
• Evidence-Based Medicine

Background:

• Venous leg ulcers (VLUs) are chronic wounds with high recurrence rates, posing a significant burden on patients and healthcare systems.
• Current management involves multiple interventions, but head-to-head comparisons of adjunctive therapies are lacking.
• VLUs cost the UK's National Health Service over £3 billion annually.

Purpose of the Study:

• To conduct a network meta-analysis comparing the efficacy of various interventions as adjuncts to compression therapy for VLU healing.
• To identify the most effective adjunctive treatment for improving complete venous leg ulcer healing rates at 24 weeks.

Main Methods:

• Systematic search of MEDLINE, EMBASE, ClinicalTrials.gov, and PubMed for relevant randomized controlled trials (RCTs) published in English.
• Inclusion of 15 RCTs with 2,571 patients, focusing on complete VLU healing at 24 weeks.
• Network meta-analysis conducted following PRISMA-NMA guidelines to compare pentoxifylline, ablation, sclerotherapy, surgery, aspirin, flavonoids, and ultrasound therapy against compression monotherapy.

Main Results:

• Both pentoxifylline (OR 3.1) and endovenous ablation (OR 2.86) demonstrated statistically significant improvements in VLU healing at 24 weeks compared to compression alone.
• No other evaluated interventions showed a statistically significant benefit in healing rates.
• Moderate heterogeneity (I² = 66.4%) and inconsistency (Q score = 20.82, p < .05) were observed across the included studies.

Conclusions:

• Pentoxifylline and endovenous ablation show promise as effective adjunctive treatments for venous leg ulcer healing.
• Results should be interpreted cautiously due to moderate heterogeneity and network inconsistency.
• Further large-scale, head-to-head RCTs are recommended to validate these findings and guide clinical practice.