Pentoxifylline was first introduced in Germany twenty years ago. Today it is the best researched oral drug for intermittent claudication. A total of seventeen placebo- controlled trials could be retrieved from the world literature. The majority of these studies show that pentoxifylline will prolong the walking distance in a statistically significant way. Even though these trials are conducted with considerable scientific rigor, important flaws can be identified. Whether the symptomatic improvement is clin ically relevant is difficult to say and may depend on the patient's individual situation. These collective data show that pentoxifylline prolongs the walking distance in patients with intermittent claudication.
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References
1.
Kannel WB, McGee DL: Update on some epidemiologic features of intermittent claudication: The Framingham Study. J Am Geriatr Soc33:13-18, 1985.
2.
Kannel WB, Skinner JJ Jr, Schwarz MG, et al: Intermittent claudication. Incidence in the Framingham Study . Circulation41:875-883, 1970.
Kappert A.: Lehrbuch und Atlas der Angiologie. Bern: Huber, 1989.
5.
Sonkin PL, Chen LE, Hatchell DL: Vasodilator action of pentoxifylline on microcirculation of rat cremaster muscle. 43:462-469, 1992.
6.
Ernst E.: Hemorheological therapy. In: Clinical Hemorheology, ed. by Chien S, Dormandy J, Ernst E, Matrai A.Dordrecht: M Nijhoff, 1987.
7.
Angelkort B. , Maurin N., Bouteng K.: Influence of pentoxifylline on erythrocyte deformability in peripheral occlusive arterial disease. Curr Med Res Opin6:225-228,1979.
8.
Johnson WC, Santissi JM, Baldwin D., et al: Treatment of claudication with pentoxifylline, are benefits related to improvement in viscosity?J Vasc Surg6:211-216, 1987.
9.
Stromer B., Kleinschmidt K., Loose D., et al: Rheological changes in the blood of patients in chronic arterial occlusive disease after administration of vasoactive drugs. Curr Med Res Opin4:588-595, 1977.
10.
Jarrett Pem , Moreland M., Browse NL: The effect of oxpentifylline (Trental) on fibrinolytic activity and on plasma fibrinogen levels. Curr Med Res Opin4:492-495, 1977.
11.
Ernst E.: Risikofaktor Fibrinogen. In: Medikamentöse und physikalische Therapie von Herz-Kreislauferkrankungen, ed. by Ernst E.Nurnberg: PIA, 1992, pp 6-16.
12.
Matrai A., Ernst E.: Pentoxifylline improves white cell rheology in claudicants. Clin Hemorheol5:483-491, 1985.
13.
Ernst E., Hammerschmidt DE, Bagge U., et al: Leukocytes and the risk of ischemic diseases. JAMA257:2318-2323, 1987.
14.
Marcel GA: Hemorheological agents. In: Pharmacological Approach to the Treatment of Limb Ischemia, ed. by Spittel JA Jr. Philadelphia: College of Physicians of Philadelphia, 1983, pp 425-440.
15.
Angelkort B. , Kiesewetter H.: Influence of risk factors and coagulation phenomena on the fluidity of blood in chronic arterial occlusive disease. Scand J Clin Lab Invest156 (Suppl):185-188, 1981.
16.
Sallivan GW , Carper HT, Novik WJ, et al: Inhibition of the inflammatory action of interleukin-1 and tumor necrosis factor alpha on neutrophil function by pentoxifylline. Infect Immunol, 56:1722-1729, 1988.
17.
Han J., Thompson P., Beutler B.: Dexamethasone and pentoxifylline inhibit endotoxin-induced cachectin/tumor necrosis factor for analysis at separate points in the signaling pathway. J Exp Med172:391-394, 1990.
18.
Ciuffetti G. , Mercuri M., Ott C., et al: Use of pentoxifylline as an inhibitor of free radical generation in peripheral vascular disease. Eur Clin Pharmacol, 41:511-515, 1991.
19.
Fowkes Fgr: Epidemiology of peripheral vascular disease. New York: Springer, 1992.
20.
Anderson B.: Methodological errors in medical research. Oxford: Blackwell, 1990.
21.
Kellner H.: Zur Behandlung chronischer arterieller Durchblutungsstörungen. Doppelblindversuch mit Trental 400. Münch Med Wschr118:1399-1410, 1976.
22.
Schubotz R.: Double blind trial of pentoxifylline in diabetics with peripheral vascular disorders. Pharmatherapeutica1:172-179, 1976.
23.
Bollinger A. , Frei C.: Double blind study of pentoxifylline against placebo in patients with intermittent claudication. Pharmatherapeutica1:557-562, 1977.
24.
Tonak J., Knecht H., Groitl H.: Treatment of circulatory disturbances with pentoxifylline: A double blind study with Trental. Pharmatherapeutica3 (Suppl 1):126-135, 1983.
25.
Völker D.: Treatment of arteriopathies with Trental 400. Results from a double blind study. Med Welt29:1244-1247, 1978 .
26.
Donaldson DR , Kester RC, et al: Does oxpentifylline (Trental) have a place in the treatment of intermittent claudication?Clin Hemorheol1:5-6, 1981.
27.
Porter JM, Cutler BC, Lee BY: Pentoxifylline efficacy in the treatment of intermittent claudication: Multicenter controlled double-blind trial with objective assessment of chronic occlusive arterial disease patients. Am Heart J104:66-72, 1982.
28.
Horowitz J. : Resultats d'une etude multicentrique, randomisee en double a veugle, pentoxifylline contre placebo. Actualites Angiol7:31-34, 1982.
29.
Buchert D., Harwart D.: Trials of 3,7 dimethyl -1 (5-Oxohexyl) xanthine (BL 191) in double blind tests . Il Farmaco31:264-274, 1976.
30.
Di Perri T., Guerrini M.: Placebo-controlled double-blind study with pentoxifylline of walking performance in patients with intermittent claudication . Angiology35:459-466, 1983.
31.
Strano A., Davi G., Avellone G., et al: Double-blind, crossover study of the clinical efficacy and the hemorheological effects of pentoxifylline in patients with occlusive arterial disease of the lower limbs. Angiology35:459-466, 1984.
32.
Roekaerts F. , Deleers L.: Trental 400 in the treatment of intermittent claudication: Results of long-term, placebo-controlled administration. Angiology35:396-406, 1984.
33.
Gallus AS, Morley AA, Gleadow F., et al: Intermittent claudication: A double-blind crossover trial of pentoxifylline. Aust N Z J Med15:402-409, 1985.
34.
Lindgärde F. : Conservative drug treatment in patients with moderately severe chronic occlusive peripheral arterial disease. Circulation80:1549-1556, 1989.
35.
Rudofsky G. , Haussler KF, Künkel HP: Intravenous treatment of chronic peripheral arterial disease, a double-blind, placebo-controlled, randomized multicenter trial of pentoxifylline. Angiology40:639-649, 1989.
36.
Dettori AG, Pini M., Moratti A., et al: Acenocoumarol and pentoxifylline in intermittent claudication. A controlled clinical study. The APIC Study Group. Angiology40:237-248, 1989.
37.
Ernst E., Kollar L., Resch KL: Does pentoxifylline prolong the walking distance in exercised claudicants. A placebo-controlled double-blind trial. Angiology43:121-125, 1992.
38.
Jonason T, Bergström: Cessation of smoking in patients with intermittent claudication. Acta Med Scand221:253-260, 1987.
39.
Cameron HA, Waller PC, Ramsay LE: Drug treatment of intermittent claudication, a critical analysis of the methods and findings of published clinical trials. Br J Clin Pharmacol26:569-576, 1988.
40.
Radack K., Wyderski RJ: Conserative management of intermittent claudication. Ann Int Med113:135-146, 1990.
41.
Ernst E.: Physical exercise for peripheral vascular disease—a review. VASA 16:227-231, 1987.
42.
Stergachis A., Sheingold S., Luce BR, et al: Medical care and cost outcomes after pentoxifylline treatment for peripheral vascular disease. Arch Intern Med152:1220-1224, 1992.
43.
Ferrari E., Fioravanti M., Patti AL, et al: Effects of long-term treatment (4 years) with pentoxifylline on haemorheological changes and vascular complications in diabetic patients . Pharmatherapeutica5:26-39, 1987.
44.
Smith LK, Skinner J.: Exercise training for claudication patients. Sports Med Training Rehab3:227, 1992.
