Alongside best medical therapy, percutaneous transluminal angioplasty (PTA) plus supervised treadmill exercise therapy (SET) could be the most beneficial first-line treatment option for intermittent claudication, according to a systematic review and network meta-analysis of 37 randomized clinical trials.
The meta-analysis “has shown that in addition to best medical therapy, angioplasty combined with supervised exercise appears to be the optimal initial treatment strategy for patients presenting with claudication,” wrote, of Guy’s and St Thomas’ Hospital in London, and colleagues.
They searched major databases for studies that compared all potential treatment options for patients with intermittent claudication. After applying the search criteria, the team found 37 clinical studies that included a total of 5 multi-arm randomized trials.
The primary outcome measure used was the improvement in Maximum Walking Distance (MWD). The secondary outcome included in the analysis was patient-reported Quality of Life (QoL).
Overall, four different treatment options for peripheral arterial disease (PAD) with intermittent claudication were compared: SET alone, PTA alone, PTA plus SET, or best medication therapy (lacking SET or PTA). In all, 2,983 patients with intermittent claudication were included.
After analysis, the researchers found that PTA plus SET was associated with a larger improvement in maximal treadmill walking distance (MWD), compared with best medication therapy alone, with an increase of 290 meters (95% confidence interval, 180-390 meters; P less than .001).
With respect to quality of life, PTA plus SET was associated with better improvement in quality of life versus best medical therapy.
The researchers acknowledged that a key limitation of the study was the lack of patient level data. As a result, detailed analyses exploring interactions between various risk parameters were not performed.
No funding sources were reported. Dr. Saratzis reported financial affiliations with the National Institute of Healthcare Research, the Academy of Medical Sciences, Amgen, Medyria Medical AG, and Regeneron.
SOURCE: Saratzis A et al. JACC Cardiovasc Interv. 2019 May 29. doi: 10.1016/j.jcin.2019.02.018.