Pharmacological management of intermittent claudication - A meta-analysis of randomised trials

Intermittent claudication, a symptom of atherosclerosis in the large vessel s of the lower limbs, greatly affects patient mobility and quality of life. Medical therapy for a moderate form of this condition includes vasodilator s, antiplatelet agents and alternative treatments such as ginkgo biloba. A meta-analysis of results from 52 trials (including 5088 patients) was con ducted for all current medical therapies for intermittent claudication. Aft er 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 distanc e 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 mode st, Antiplatelets, ginkgo biloba and levocarnitine were slightly more effec tive than placebo, although the treatment benefit was of limited clinical i mportance. On average, patients walked 60m further with therapy than withou t, and only about half of that added distance was pain-free. Very little co nsistent information was available for other clinical end-points, such as o verall mortality and adverse effects. These data suggest that some of the medical therapy, pentoxifylline in part icular, can only modestly increase functional status in patients with moder ate intermittent claudication. There is a need for uniformity in research d esign and reporting of trials. A future trial comparing medical therapy wit h physical therapy is indicated.