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Naftidrofuryl oxalate, cilostazol effective for claudication

Clinical Question:
What drugs are effective in treating patients with intermittent claudication?

Bottom Line:
Naftidrofuryl oxalate and cilostazol are effective in increasing maximum walking distance and pain-free walking distance in patients with claudication. (LOE = 1a-)

Reference:
Stevens JW, Simpson E, Harnan S, et al. Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg 2012;99(12):1630-1638.  [PMID:23034699]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Government

Setting:
Various (meta-analysis)

Synopsis:
These authors searched multiple databases looking for clinical trials of medications used to treat patients who had intermittent claudication for at least 24 weeks. They also searched registries to identify unpublished studies. One researcher chose the included studies but consulted with "a clinical advisor when necessary." (I have no idea what that means.) One author extracted the data, but a different author double-checked the work. Although they assessed the quality of studies, the authors don't describe if this was done in a paired, independent, masked fashion. The more typical approach to meta-analyses is to have at least 2 authors independently assess study inclusion, and assess quality, and to use an explicit adjudication process for disagreements. Ultimately, these authors included 10 randomized trials that assessed maximum walking distance and 11 that assessed pain-free walking distance. The trials ranged in size from 61 patients to 520 patients and were generally of short duration (6 months or less). Three medications were assessed in these studies: cilostazol, pentoxifylline, and naftidrofuryl oxalate. None of the included studies evaluated inositol nicotinate. The authors don't describe the role of smoking status or whether the trials included exercise as a co-intervention. The authors used a network analysis that allows the simultaneous comparison between the different treatments. The maximum walking distance improved in patients who took cilostazol or naftidrofuryl oxalate, and the pain-free walking distance improved in patients who took any of the 3 study drugs. The authors don't provide enough information to tell if the improvements are clinically significant. Of the 3 drugs, naftidrofuryl oxalate appeared to provide greater degrees of improvement. The authors provide no relevant data about the types and rates of adverse events.

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