Micronized Purified Flavonoid Fraction (MPFF) for Patients Suffering from Chronic Venous Disease: A Review of New Evidence

Abstract

Chronic venous disease (CVD) is both prevalent and unavoidable in many people as a result of persistent or unalterable risk factors, the most important of which are advanced age, excess body weight, and family history. Given this inevitability, medical treatment is required to alleviate symptoms and slow disease progression. Venoactive drug therapy is emerging as a valuable treatment option for many CVD patients and micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available. Recent evidence from animal models of venous hypertension and from clinical trials, as well as from systematic reviews, shows that MPFF is effective at alleviating many of the most common symptoms of CVD including leg pain, leg heaviness, sensations of swelling, cramps, and functional discomfort. In addition, MPFF improves the clinical signs of redness, skin changes, and edema, and improves quality of life. Collectively, these findings support the strong recommendation for MPFF treatment found in the 2018 international guidelines for the management of CVD.Funding: Servier.

Efficacy of a Low-Dose Diosmin Therapy on Improving Symptoms and Quality of Life in Patients with Chronic Venous Disease: Randomized, Double-Blind, Placebo-Controlled Trial

“…In this study, QoL assessed by GIS and calculated through the CIVIQ-20 questionnaire was significantly improved at the end of treatment in the active group compared to the placebo group. Such results agree with those published previously, obtained after treatment with micronized diosmin or MPFF at higher dosages (1000 mg/day) or longer periods (up to 6 months or longer) [ 19 , 48 , 49 ].…”

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…268 In 2018 and 2019, two reviews on MPFF supported its use in all the 6 CEAP clinical classes. 269,270 Because of the significant amount of literature on VAD for venous ulcer treatment has unclear risk of bias for randomization, allocation concealment and blinding, a 2016 systematic review concluded that pentoxifylline (400 mg, three times a day) was the only drug showing promise as an effective adjunct to venous ulcer treatment. 271 Yet, pentoxifylline is currently unlicensed and the ESVS European guidelines recommend against its use.…”

“…In 2018 and 2019, two reviews on MPFF supported its use in all the 6 CEAP clinical classes. 269 , 270…”

New Insights into the Metabolism of the Flavanones Eriocitrin and Hesperidin: A Comparative Human Pharmacokinetic Study

“…There are drugs like Daflon ® 500 mg (micronized purified flavonoid fraction of 50 mg flavonoids (expressed as hesperidin) plus 450 mg of diosmin, a semisynthetic analog) that are used in the treatment of venous insufficiency and has shown its effectivity in improving leg symptoms, edema, and quality of life in patients with the chronic venous disease [ 12 , 13 ]. Paradoxically, despite its medical prescription and commercialization, the European Food Safety Authority (EFSA) has refused the health claim “maintenance of physiological venous-capillary permeability” associated with the intake of flavonoids like hesperidin, diosmin, and troxerutin [ 14 ].…”