Pharmacological adjuncts for chronic venous ulcer healing: a systematic review

Varatharajan, Lavanya; Thapar, Ankur; Lane, Tristan; Munster, Alex B.; Davies, Alun H.

doi:10.1177/0268355515587194

Cited by 22 publications

(16 citation statements)

References 40 publications

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“…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. 6 In the same year, a Cochrane analysis on phlebotonics (rutosides, hidrosmin and diosmin, calcium dobesilate, centella asiatica, aminaftone, French maritime pine bark extract and grape seed extract) for venous insufficiency concluded that VAD may have a beneficial effect on oedema and on some signs and symptoms related to chronic venous insufficiency (trophic disorders, cramps, restless legs, paresthesia) when compared to placebo, but can also produce adverse effects.…”

Section: Significant Recent Data Related To the Meeting Discussionmentioning

confidence: 99%

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

et al. 2019

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Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.

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Section: Significant Recent Data Related To the Meeting Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Thus, strategies aimed at inhibiting the expression of this cytokine have been suggested to decrease the pro-inflammatory macrophage effect. The local administration of common painkillers such as aspirin [317], ibuprofen [318], and pentoxifylline [319] has shown interesting results in TNF-α reduction. The anti-TNF-α molecule conveyed by hyaluronic acid, taking advantage of the specific receptor (CD44) on macrophages, provides the signal directly to the cytokine producing cell [320].…”

Section: Immune-interactive Strategiesmentioning

confidence: 99%

Biomaterials: Foreign Bodies or Tuners for the Immune Response?

Mariani

Lisignoli

Borzı̀

et al. 2019

IJMS

443

374

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The perspectives of regenerative medicine are still severely hampered by the host response to biomaterial implantation, despite the robustness of technologies that hold the promise to recover the functionality of damaged organs and tissues. In this scenario, the cellular and molecular events that decide on implant success and tissue regeneration are played at the interface between the foreign body and the host inflammation, determined by innate and adaptive immune responses. To avoid adverse events, rather than the use of inert scaffolds, current state of the art points to the use of immunomodulatory biomaterials and their knowledge-based use to reduce neutrophil activation, and optimize M1 to M2 macrophage polarization, Th1 to Th2 lymphocyte switch, and Treg induction. Despite the fact that the field is still evolving and much remains to be accomplished, recent research breakthroughs have provided a broader insight on the correct choice of biomaterial physicochemical modifications to tune the reaction of the host immune system to implanted biomaterial and to favor integration and healing.

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“…As an example, adding pentoxifylline treatment to compression therapy significantly improves venous ulcer healing rates versus compression therapy alone or if combined with placebo, and also reduces treatment costs [45]. A cost-effectiveness analysis of this adjunct pentoxifylline treatment, which costs GB£6 per month, suggested that the combined treatment costs only GB£98 (95% CI − 49.2 to 245.0) per quality-adjusted life year (QALY) gained [45]. As a point of reference, the cost-effectiveness threshold in the UK is considered to be GB£20,000 per QALY gained, so adjunct pentoxifylline therapy is likely to be extremely cost-effective.…”

Section: Venous Leg Ulcersmentioning

confidence: 99%

The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence

2019

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Chronic venous disease (CVD) is a prevalent condition that tends to worsen with age. Patients initially seek treatment to relieve symptoms of leg pain, discomfort, heaviness and swelling, all of which impact their quality of life. As the disease increases in severity to include varicose veins, skin changes, and venous ulcer, the demand for treatment increases while the quality of life further diminishes. The prevalence of CVD is highest in Western countries where it already consumes up to 2% of healthcare budgets. With the aging of the global population, the prevalences of CVD and severe CVD are projected to increase substantially, foretelling unsustainably large increases in the healthcare resources and costs needed to treat CVD patients in the coming decades. Effective venoactive drug treatments and ablation procedures are available that provide symptom relief, improve quality of life, slow disease progression, and promote ulcer healing. In addition, venoactive drug treatments may be highly cost-effective. However, there is evidence that physician awareness of CVD is suboptimal and that many patients with CVD are not being treated or referred to specialists according to established guidelines. To decrease this treatment gap and prevent unnecessary disease progression, international guidelines are available to help physicians consider CVD treatment options and refer patients when warranted. Improved disease awareness and appropriate early treatment may help reduce the coming burden of CVD.Funding: Servier.

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Pharmacological adjuncts for chronic venous ulcer healing: a systematic review

Abstract: Many systemic pharmacological agents have been investigated as adjuncts to venous ulcer healing; however, pentoxifylline (400 mg, three times a day) is currently the only drug that has promising evidence to support its use. Other compounds are in early stage research.

Cited by 22 publications

References 40 publications

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

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

Biomaterials: Foreign Bodies or Tuners for the Immune Response?

The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence

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