Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies.
OBJECTIVE
To evaluate the efficacy of pharmacological interventions in improving walking capacity and health-related quality of life for people with intermittent claudication. DATASOURCES: We searched Medline, EMBASE, Cochrane library and relevant websites for studies published from the start of the databases to February 2009. In addition, reference lists were manually searched.


METHODS
Based upon a power calculation, only robust (n>56), peer-reviewed, double-blinded, randomised and placebo-controlled trials were included. The main outcomes evaluated were maximal walking distance (MWD) and pain-free walking distance on a treadmill. Random models were used in the statistical analysis, and chi-square test were used to test for heterogeneity.


RESULTS
Among 220 trials, only 43 trials fulfilled the quality criteria. Treatment periods, follow-up and treadmill protocols varied substantially. Vasodilator agents and phosphodiesterase inhibitors show robust significant results compared to placebo, but the improvements in MWD are modest. The highest benefit was caused by lipid-lowering agents, which in mean gained above 160 m in MWD, while the other agents only improved MWD about 50 m.


CONCLUSIONS
Several drugs have shown to improve MWD, but with limited benefits. Statins seem to be the most efficient drug at the moment.
Momsen
A H
AH
Department of Surgery, Regional Hospital Herning, Denmark. anmom@ringamt.dk
Jensen
M B
MB
Norager
C B
CB
Madsen
M R
MR
Vestersgaard-Andersen
T
T
Lindholt
J S
JS
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005080:Exercise Test; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007383:Intermittent Claudication / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D016138:Walking
D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010726:Phosphodiesterase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents