Pentoxifylline for treatment of venous leg ulcers: a systematic review

Introduction Venous ulcers are usually treated with compression therapy, but, because this treatment may not be effective for some people, adjuvant therapy could be beneficial. We did a systematic review of randomised controlled trials that compared pentoxifylline (with and without compression treatment) with placebo, or other treatments, in patients with venous leg ulcers. Methods We identified eight trials (547 adults), five of which compared pentoxifylline and compression with placebo and compression (n=445), and three of which compared pentoxifylline alone with placebo (102). Our main aim was to determine whether pentoxifylline, with or without compression, was effective in treatment of venous leg ulcers. Analysis was by intention to treat. Findings Pentoxifylline was more effective than placebo in complete healing or substantial improvement of venous leg ulcers (relative risk 1•49, 95% Cl 1•11–2•01). Pentoxifylline with compression was also more effective than placebo and compression in complete healing (1•30, 1•10–1•54). Patients taking pentoxifylline had no more adverse events than those on placebo (1•25, 0•87–1•80). The most frequent adverse event was mild gastrointestinal disturbance (43%). Interpretation Our results suggest that pentoxifylline gives additional benefit to compression for venous leg ulcers, and is possibly effective for patients not receiving compression.