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A New Pharmacological Treatment for Intermittent Claudication:
Results of a Randomized, Multicenter Trial
Hugh G. Beebe, MD;
David L. Dawson, MD;
Bruce S. Cutler, MD;
J. Alan Herd, MD;
D. Eugene Strandness, Jr, MD;
Enoch B. Bortey, PhD;
William P. Forbes, PharmD
Arch Intern Med. 1999;159:2041-2050.
Background Effective medication is limited for the relief of intermittent claudication, a common manifestation of arterial occlusive disease. Cilostazol is a potent inhibitor of platelet aggregation with vasodilation effects.
Objective To evaluate the safety and efficacy of cilostazol for the treatment of intermittent claudication.
Methods Thirty-seven outpatient vascular medicine clinics at regional tertiary and university hospitals in the United States participated in this multicenter, randomized, double-blind, placebo-controlled, parallel trial. Of the 663 screened volunteer patients with leg discomfort, a total of 516 men and women 40 years or older with a diagnosis of moderately severe chronic, stable, symptomatic intermittent claudication were randomized to receive cilostazol, 100 mg, cilostazol, 50 mg, or placebo twice a day orally for 24 weeks. Outcome measures included pain-free and maximal walking distances via treadmill testing, patient-based quality-of-life measures, global assessments by patient and physician, and cardiovascular morbidity and all-cause mortality survival analysis.
Results The clinical and statistical superiority of active treatment over placebo was evident as early as week 4, with continued improvement at all subsequent time points. After 24 weeks, patients who received cilostazol, 100 mg, twice a day had a 51% geometric mean improvement in maximal walking distance (P<.001 vs placebo); those who received cilostazol, 50 mg, twice a day had a 38% geometric mean improvement in maximal walking distance (P<.001 vs placebo). These percentages translate into an arithmetic mean increase in distance walked, from 129.7 m at baseline to 258.8 m at week 24 for the cilostazol, 100 mg, group, and from 131.5 to 198.8 m for the cilostazol, 50 mg, group. Geometric mean change for pain-free walking distance increased by 59% (P<.001) and 48% (P<.001), respectively, in the cilostazol, 100 mg, and cilostazol, 50 mg, groups. These results were corroborated by the results of subjective quality-of-life assessments, functional status, and global evaluations. Headache, abnormal stool samples or diarrhea, dizziness, and palpitations were the most commonly reported potentially drug-related adverse events and were self-limited. A total of 75 patients (14.5%) withdrew because of any adverse event, which was equally distributed between all 3 treatment groups. Similarly, there were no differences between groups in the incidence of combined cardiovascular morbidity or all-cause mortality.
Conclusion Compared with placebo, long-term use of cilostazol, 100 mg or 50 mg, twice a day significantly improves walking distances in patients with intermittent claudication.
From the Jobst Vascular Center, Toledo, Ohio (Dr Beebe); Wilford Hall Medical Center (Dr Dawson), Lackland Air Force Base, San Antonio, Tex; University of Massachusetts Medical Center (Dr Cutler), Worcester; The Methodist Hospital, Houston, Tex (Dr Herd); University of Washington Medical School, Seattle (Dr Strandness); and Otsuka America Pharmaceutical Inc, Rockville, Md (Drs Bortey and Forbes).
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