Prostanoids in the treatment of intermittent claudication -: a meta-analysis

Background: Numerous studies have established the efficacy of prostanoids in PAD stages III and IV, but the role of prostanoids as an alternative or additive treatment inpatients suffering from PAD II is less clear. To resolve this uncertainty we performed a meta-analysis of all randomised controlled studies analysing effects of prostanoids in patients suffering from intermittent claudication. Methods: 96 studies have been screened by computerised searches of MEDLINE and EMBASE. Relevant studies were pooled in Cochrane's Review-manager 4.1. Results: 19 studies were included for further analysis. Five studies could not be pooled for analysing walking distances, because standard deviations were not stated. Eight studies compared effects of any prostanoid iv vs. placebo. In total 557 patients (281/276) were included for analysis of painfree - walking distance (PFWD) and 519 patients (2621257) for analysis of maximum walking distance (MWD). Prostanoids compared to placebo significantly improved mean PFWD by 28% (7%-49%, P = 0,008) and mean MWD by 30% (11%-50%, P = 0,002). At least one adverse reaction was reported from 39,6% of the patients treated with prostacyclin and its analogues and from 13,7% of the patients treated with prostaglandin E-1. Conclusion: Patients suffering from intermittent claudication benefit from administration of prostaglandin E-1 by a significant improvement of their walking capacity.