Is Cilostazol More Effective Than Pentoxifylline for Intermittent Claudication with PAD?
the MPR take:
Intermittent claudication is estimated to occur in 40% of patients with lower limb peripheral arterial disease (PAD), with the symptoms known to be indicators for systemic atherosclerosis. While cardiovascular risk factor modification is the primary treatment, as many as a third of patients do not achieve symptomatic relief of intermittent claudication with therapy compliance. A review in the Cochrane Library evaluated 15 double-blind, randomized-controlled trials of cilostazol vs. placebo or other antiplatelet agents on improving initial and absolute claudication distances and in reducing mortality and vascular events in patients with stable intermittent claudication. Treatment for the 3,718 participants varied from six to 26 weeks; trials included use of cilostazol twice daily (50mg, 100mg, and 150mg vs. placebo and cilostazol 100mg twice daily vs. pentoxifylline 400mg three times daily. For initial claudication distance (ICD) and absolute claudication distance (ACD), the cilostazol arm showed improvement at 50 and 100mg twice daily vs. placebo. Improvement in ICD and ACD was also evident for cilostazol 150mg vs. placebo and cilostazol 100mg vs. pentoxifylline, but the evidence was limited to two studies. No association was seen between treatment type and all-cause mortality in any comparison, but few events were reported. While this study does support cilostazol in improving walking distance in patients with intermittent claudication secondary to PAD, other benefits such as all-cause mortality risk reduction, improvement in quality of life, and cardiovascular event risk reduction need further examination in future research.
To determine the effect of cilostazol (an antiplatelet treatment) on improving initial and absolute claudication distances, and in reducing mortality and vascular events in patients with stable intermittent claudication.