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Prostanoids for intermittent claudication.

Abstract

BACKGROUND

Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity in the general population. While numerous studies have established the efficacy of prostanoids in PAOD stages III and IV the question of the role of prostanoids as an alternative or additive treatment in patients suffering from claudicatio intermittens (PAOD II) has not yet been clearly answered.

OBJECTIVES

The aim of this review was to evaluate effects of prostanoids in patients with intermittent claudication.

SEARCH STRATEGY

Computerised searches of the Cochrane Peripheral Vascular Diseases Specialised Register (last searched April 2003), The Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003), MEDLINE and EMBASE were undertaken. In addition relevant journals were hand-searched.

SELECTION CRITERIA

Randomized clinical trials describing the effects of prostanoids in the treatment of patients suffering from intermittent claudication have been considered for inclusion.

DATA COLLECTION AND ANALYSIS

All reviewers assessed the quality of studies and extracted data unblinded. Statistical analysis including tests for heterogeneity and overall effect were performed by using MetaView of Review Manager 4.2. All numeric values are expressed as mean +/- Standard deviation (SD).

MAIN RESULTS

Eighteen studies were included for analysis. A significant heterogeneity between the included studies was detected in most of the subgroup analysis. Five studies compared the effects of prostaglandin E1 (PGE1) versus placebo, and reported in their individual results significant increases in walking distances after the administration of PGE1. The attained increase in walking distances appears to be not merely a short-term effect because several studies reported that walking capacity remained increased even after termination of treatment. On the other hand, oral or intravenous prostacyclin did not increase the walking distances significantly. At least one adverse reaction was reported from 23.6% of the patients treated with prostacyclin (PGI2), and its analogues and from 13.7% of the patients treated with PGE1.

REVIEWER'S CONCLUSIONS

Because of the heterogeneity between most of the included studies, we did not pool relevant parts of the data by meta-analysis. Based on the individual results of the published literature, patients with intermittent claudication seem to benefit from administration (intravenous or intra-arterial) of PGE1 by a significant improvement of their walking capacity. Further well-conducted randomized, double blinded trials, with a sufficient number of patients to provide statistical powerful information, should be performed to confirm the results of this review.

Authors+Show Affiliations

Department of Medical Angiology, University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, Vienna, Austria. Markus.Reiter@akh-wien.ac.atNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

14973962

Citation

Reiter, M, et al. "Prostanoids for Intermittent Claudication." The Cochrane Database of Systematic Reviews, 2004, p. CD000986.
Reiter M, Bucek RA, Stümpflen A, et al. Prostanoids for intermittent claudication. Cochrane Database Syst Rev. 2004.
Reiter, M., Bucek, R. A., Stümpflen, A., & Minar, E. (2004). Prostanoids for intermittent claudication. The Cochrane Database of Systematic Reviews, (1), CD000986.
Reiter M, et al. Prostanoids for Intermittent Claudication. Cochrane Database Syst Rev. 2004;(1)CD000986. PubMed PMID: 14973962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prostanoids for intermittent claudication. AU - Reiter,M, AU - Bucek,R A, AU - Stümpflen,A, AU - Minar,E, PY - 2004/2/20/pubmed PY - 2004/6/30/medline PY - 2004/2/20/entrez SP - CD000986 EP - CD000986 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity in the general population. While numerous studies have established the efficacy of prostanoids in PAOD stages III and IV the question of the role of prostanoids as an alternative or additive treatment in patients suffering from claudicatio intermittens (PAOD II) has not yet been clearly answered. OBJECTIVES: The aim of this review was to evaluate effects of prostanoids in patients with intermittent claudication. SEARCH STRATEGY: Computerised searches of the Cochrane Peripheral Vascular Diseases Specialised Register (last searched April 2003), The Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003), MEDLINE and EMBASE were undertaken. In addition relevant journals were hand-searched. SELECTION CRITERIA: Randomized clinical trials describing the effects of prostanoids in the treatment of patients suffering from intermittent claudication have been considered for inclusion. DATA COLLECTION AND ANALYSIS: All reviewers assessed the quality of studies and extracted data unblinded. Statistical analysis including tests for heterogeneity and overall effect were performed by using MetaView of Review Manager 4.2. All numeric values are expressed as mean +/- Standard deviation (SD). MAIN RESULTS: Eighteen studies were included for analysis. A significant heterogeneity between the included studies was detected in most of the subgroup analysis. Five studies compared the effects of prostaglandin E1 (PGE1) versus placebo, and reported in their individual results significant increases in walking distances after the administration of PGE1. The attained increase in walking distances appears to be not merely a short-term effect because several studies reported that walking capacity remained increased even after termination of treatment. On the other hand, oral or intravenous prostacyclin did not increase the walking distances significantly. At least one adverse reaction was reported from 23.6% of the patients treated with prostacyclin (PGI2), and its analogues and from 13.7% of the patients treated with PGE1. REVIEWER'S CONCLUSIONS: Because of the heterogeneity between most of the included studies, we did not pool relevant parts of the data by meta-analysis. Based on the individual results of the published literature, patients with intermittent claudication seem to benefit from administration (intravenous or intra-arterial) of PGE1 by a significant improvement of their walking capacity. Further well-conducted randomized, double blinded trials, with a sufficient number of patients to provide statistical powerful information, should be performed to confirm the results of this review. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/14973962/Prostanoids_for_intermittent_claudication_ L2 - https://doi.org/10.1002/14651858.CD000986.pub2 DB - PRIME DP - Unbound Medicine ER -