Given the pooled results of these clinical trials, it appears that pentoxifylline is beneficial as an adjuvant treatment for venous ulcers. Of note, some of the studies included in the meta-analysis conducted by the Cochrane group did not individually show statistical significance. Moreover, the dose of pentoxifylline used in the studies varied, and there is a legitimate question regarding the optimal dosing for the treatment of patients with venous ulcers. For example, in the study by Falanga et al., the dose of pentoxifylline used was greater than that used to treat intermittent claudication (800 mg versus 400 mg three times daily).9
In some of the studies included in the Cochrane meta-analysis patients did not necessarily receive compression as standard care. Even including these studies, however, pentoxifylline therapy was shown to be more beneficial than placebo, resulting in a higher proportion of patients healed by the study endpoint. However, it is important to note that this was a relative benefit, and that the relative benefit of pentoxifylline over placebo persisted even for patients treated with compression. Since compression therapy has been shown to increase the baseline chance of healing, patients treated with pentoxifylline should always be treated with compression therapy as well.
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