Pharmacological treatment for Buerger's disease

Abstract

Moderate quality evidence suggests that intravenous iloprost (prostacyclin analogue) is more effective than aspirin for eradicating rest pain and healing ischaemic ulcers in Buerger's disease, but oral iloprost is not more effective than placebo. Verylow and low quality evidence suggests there is no difference between prostacyclin (iloprost and clinprost) and the prostaglandin analogue alprostadil for healing ulcers and relieving pain respectively in severe Buerger's disease. Very-low quality evidence suggests there is no difference in pain scores and amputation rates between folic acid and placebo, in people with Buerger's disease and hyperhomocysteinaemia. High quality trials assessing the effectiveness of pharmacological agents (intravenous or oral) in people with Buerger's disease are needed.

Efficacy of bosentan in patients with refractory thromboangiitis obliterans (Buerger disease)

“…In addition to discontinuation of cigarette smoking, only intravenous prostaglandin has demonstrated proven efficacy, but its effect fades upon finishing treatment (21–28 days). [3] More recently, bosentan has been introduced in refractory cases of TAO, bringing in a new alternative for prolonged oral treatment. [9–15] …”

“…Different treatments such as antiplatelet agents, anticoagulants, and vasodilators (including calcium channel blockers, pentoxyfylline, and cilostazol) are widely used, although there is no proven evidence of their palliative benefits. [3,4] Prostaglandin analogs are beneficial when administered intravenously, although they are no better than placebo on oral administration, and the beneficial effects are transient and disappear after treatment is stopped. [3] Surgical techniques (revascularization, sympathectomy, Ilizavor technique, and omentopexy omentum autografts) are limited in scope and usefulness.…”

“…[3,4] Prostaglandin analogs are beneficial when administered intravenously, although they are no better than placebo on oral administration, and the beneficial effects are transient and disappear after treatment is stopped. [3] Surgical techniques (revascularization, sympathectomy, Ilizavor technique, and omentopexy omentum autografts) are limited in scope and usefulness. [4] New therapeutic options with greater efficacy are clearly needed to properly manage these patients.…”

Buerger’s Disease: Clinical Aspects and Evidence-Based Treatments

“…It is important to cite the degree of evidence of these treatments. In a recent Cochrane systematic review on the pharmacological treatment of thromboangiitis [36], prostacyclin analog versus placebo, aspirin, and a prostaglandin analog, and folic acid versus placebo were included. Studies that evaluated pharmacological agents such as cilostazol, clopidogrel, and pentoxifylline, or studies that compared oral prostanoid versus intravenous prostanoid were not incorporated because they were not randomized controlled trials.…”

“…Studies that evaluated pharmacological agents such as cilostazol, clopidogrel, and pentoxifylline, or studies that compared oral prostanoid versus intravenous prostanoid were not incorporated because they were not randomized controlled trials. Moderate evidence (one study) suggested that intravenous iloprost was effective in participants with critical limb ischemia (ulcers and rest pain) after 4 weeks of treatment when compared with aspirin, without differences in amputation rates [36]. Two trials indicate that prostacyclin was very effective as prostaglandin analogs in healing ulcers (very low-quality evidence) and extinguishing pain at rest (low-quality evidence), but rates of amputation were not reported by the authors [36].…”