Cilostazol (Pletal) and pentoxifylline (Trental) are commonly used to treat intermittent claudication, a condition causing pain in the legs and feet due to reduced blood flow. This article analyzes a study comparing the effectiveness of 100mg of Pletal with 400mg of Trental in treating this condition.
Comparing Cilostazol and Pentoxifylline for Intermittent Claudication
A randomized, double-blind, placebo-controlled trial was conducted across 54 outpatient vascular clinics in the United States. The study aimed to determine if 100mg of cilostazol twice daily was comparable to 400mg of pentoxifylline three times daily in improving walking distance for patients with moderate to severe intermittent claudication. 698 patients were randomly assigned to one of three groups: cilostazol, pentoxifylline, or a placebo.
Study Methodology and Results
Maximal walking distance was measured using a treadmill test at baseline and at regular intervals over 24 weeks. The cilostazol group consistently showed significantly greater improvement in walking distance compared to both the pentoxifylline and placebo groups at each follow-up assessment.
After 24 weeks, the cilostazol group experienced a mean increase in walking distance of 107 meters (54% improvement from baseline). The pentoxifylline group showed a 64-meter increase (30% improvement), while the placebo group had a 65-meter increase (34% improvement). The difference between cilostazol and pentoxifylline was statistically significant (P < 0.001), whereas pentoxifylline and placebo showed similar results (P = 0.82). This indicates that 100mg of Pletal is not comparable to 400mg of Trental in terms of efficacy.
The rates of death and serious adverse events were comparable across all three groups. However, cilostazol was associated with a higher frequency of minor side effects, such as headache, palpitations, and diarrhea. Despite this, withdrawal rates were similar between the cilostazol (16%) and pentoxifylline (19%) groups.
Conclusion: Cilostazol Demonstrates Superior Efficacy
This study demonstrates that cilostazol is significantly more effective than pentoxifylline or placebo in improving walking distance for patients with intermittent claudication. While cilostazol was associated with more minor side effects, the difference in efficacy suggests that it may be a preferred treatment option for some patients. Pentoxifylline, at the dosage studied, did not offer significant benefits over placebo. While this study directly compares 100mg of Pletal to 400mg of Trental, further research may be needed to explore different dosages or combination therapies.
