Pharmacological Approaches to the Treatment of Intermittent Claudication???

Abstract

Intermittent claudication is a common condition of the elderly, occurring in 3 to 20% of individuals over the age of 65 years. Although local disease is usually benign, life expectancy in patients with intermittent claudication is reduced by approximately 10 years due to associated cardiovascular mortality. Several classes of drugs have been used in intermittent claudication, but clinical studies evaluating their efficacy leave much to be desired. Pentoxifylline (oxpentifylline), a rheological agent, and naftidrofuryl, an enhancer of aerobic metabolism, are the 2 most widely investigated and utilised drugs. The combined results of 10 placebo-controlled studies with pentoxifylline and 4 with naftidrofuryl estimate increases in claudication distances of 51 and 42%, respectively. However, due to publication bias, these figures are probably overestimates of the true benefit from treatment with these drugs. It is likely that any benefit from pentoxifylline or naftidrofuryl is small and of little clinical importance. The suggestion that naftidrofuryl has greater efficacy in older patients remains unproven. Other classes of drugs including vasodilators, antiplatelet drugs, anticoagulants and prostaglandins have not been shown to be effective. Only 2 approaches to the management of intermittent claudication have been shown convincingly to be of benefit: stopping smoking and exercising regularly.

Effect of Intermittent Pneumatic Compression of Foot and Calf on Walking Distance, Hemodynamics, and Quality of Life in Patients With Arterial Claudication

“…17 Meta-analyses of all randomized studies on the effect of pentoxifylline, the best-studied agent, revealed an improvement in claudication by 20 -44 m. 55,56 Similar or worse results are reported on the effect of other medications. 17,57,58 Supervised exercise emerges as the most effective noninvasive treatment option in claudication. 17 A meta-analysis of 21 English-language articles on exercise rehabilitation programs reported a mean increase in ICD by 179% and in ACD by 122%.…”

Oral Naftidrofuryl

“…Stage II disease occurs with a prevalence of less than 1.5% in patients younger than 50 years, 5% in patients aged between 50 and 65 years and as high as 18% in patients olderthan 65 yearsJl20] Men are twice as likely as women to develop POAD. [ 122 l Although local disease may be benign in the majority of patients, life expectancy is considerably reduced in patients with POAD as a result of associated cardiovascular mortalityJl24] Fewer than 50% of patients with intermittent claudication are expected to survive more than 10 yearsJI21 , 124] The most common symptom of POAD is intermittent claudication, involving pain, cramp and numbness or fatigue of the muscles, which occurs during exercise but is relieved by rest. [120] The amputation rate in the UK is estimated to be 140/miliion/year.…”

Naftidrofuryl for intermittent claudication: meta-analysis based on individual patient data

“…This drug has been marketed since 1968 on the basis of presumed vascular, antiplatelet, and intracellular actions 35. Numerous reviews on naftidrofuryl have been published36 37 38 39 40 41 42 and the drug is mentioned in European and transatlantic guidelines,43 44 but no final judgment on its efficacy has been made by the modern approach of systematic meta-analysis. In the one systematic review on naftidrofuryl, five of six eligible randomised clinical trials showed a significant, albeit modest, effect 34.…”