Pentoxifylline is a trisubstituted xanthine derivative that has been used to treat a variety of systemic disorders, most notably intermittent claudication.9 Theoretically, its beneficial effects in vaso-occlusive disease could extend to therapy for venous ulcers, and so several studies have explored the potential benefits of pentoxifylline in treating patients with venous leg ulcers.

A Cochrane collaborative review has addressed the efficacy of pentoxifylline for the treatment of venous ulcers.10 Nine trials including 572 patients were included in the Cochrane review. Of note, only five of the trials included compression therapy in both the pentoxifylline and placebo groups. One of the included trials compared pentoxifylline with defibrotide rather than placebo, and was therefore excluded from the meta-analysis used to evaluate the potential benefit of pentoxifylline.

Combining the data from the eight trials that compared pentoxifylline (in varying doses) with placebo, pentoxifylline demonstrated a beneficial effect. The relative risk of healing with pentoxifylline versus placebo was 1-41 (CI 1-19-1-66). A separate examination of just the trials that compared pentoxifylline plus compression with placebo plus compression also showed a benefit of pentoxifylline therapy with a relative risk of 1-30 (CI 1-10-1-54). Most of the studies used the probability of healing by 24 weeks as the endpoint.

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