The Queensland Research Centre for Peripheral Vascular Disease (QRC-PVD) College of Medicine and Dentistry James Cook University Townsville Queensland Australia.
The Australian Institute of Tropical Health and Medicine James Cook University Townsville Queensland Australia.
J Am Heart Assoc. 2021 May 4;10(9):e019672. doi: 10.1161/JAHA.120.019672. Epub 2021 Apr 23.
Background No network meta-analysis has considered the relative efficacy of cilostazol, home exercise therapy, supervised exercise therapy (SET), endovascular revascularization (ER), and ER plus SET (ER+SET) in improving maximum walking distance (MWD) over short- (<1 year), moderate- (1 to <2 years), and long-term (≥2 years) follow-up in people with intermittent claudication. Methods and Results A systematic literature search was performed to identify randomized controlled trials testing 1 or more of these 5 treatments according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The primary outcome was improvement in MWD assessed by a standardized treadmill test. Secondary outcomes were adverse events and health-related quality of life. Network meta-analysis was performed using the gemtc R statistical package. The Cochrane collaborative tool was used to assess risk of bias. Forty-six trials involving 4256 patients were included. At short-term follow-up, home exercise therapy (mean difference [MD], 89.4 m; 95% credible interval [CrI], 20.9-157.7), SET (MD, 186.8 m; 95% CrI, 136.4-237.6), and ER+SET (MD, 326.3 m; 95% CrI, 222.6-430.6), but not ER (MD, 82.5 m; 95% CrI, -2.4 to 168.2) and cilostazol (MD, 71.1 m; 95% CrI, -24.6 to 167.9), significantly improved MWD (in meters) compared with controls. At moderate-term follow-up, SET (MD, 201.1; 95% CrI, 89.8-318.3) and ER+SET (MD, 368.5; 95% CrI, 195.3-546.9), but not home exercise therapy (MD, 99.4; 95% CrI, -174.0 to 374.9) or ER (MD, 84.2; 95% CrI, -35.3 to 206.4), significantly improved MWD (in meters) compared to controls. At long-term follow-up, none of the tested treatments significantly improved MWD compared to controls. Adverse events and quality of life were reported inconsistently and could not be meta-analyzed. Risk of bias was low, moderate, and high in 4, 24, and 18 trials respectively. Conclusions This network meta-analysis suggested that SET and ER+SET are effective at improving MWD over the moderate term (<2 year) but not beyond this. Durable treatments for intermittent claudication are needed.
尚无网络荟萃分析考虑西洛他唑、家庭运动疗法、监督运动疗法（SET）、血管内血运重建（ER）以及 ER 联合 SET（ER+SET）在改善间歇性跛行患者短期（<1 年）、中期（1 年至<2 年）和长期（≥2 年）随访时最大步行距离（MWD）方面的相对疗效。
按照系统评价和荟萃分析首选报告项目的指南，我们进行了系统文献检索，以确定 1 种或多种以下 5 种治疗方法的随机对照试验。主要结局为使用标准化跑步机测试评估的 MWD 改善。次要结局为不良事件和健康相关生活质量。使用 gemtc R 统计软件包进行网络荟萃分析。使用 Cochrane 协作工具评估偏倚风险。
纳入了 46 项涉及 4256 名患者的试验。短期随访时，家庭运动疗法（平均差值 [MD]，89.4m；95%可信区间 [CrI]，20.9-157.7）、SET（MD，186.8m；95% CrI，136.4-237.6）和 ER+SET（MD，326.3m；95% CrI，222.6-430.6），而非 ER（MD，82.5m；95% CrI，-2.4 至 168.2）和西洛他唑（MD，71.1m；95% CrI，-24.6 至 167.9），与对照组相比，显著改善了 MWD（以米计）。中期随访时，SET（MD，201.1；95% CrI，89.8-318.3）和 ER+SET（MD，368.5；95% CrI，195.3-546.9），而非家庭运动疗法（MD，99.4；95% CrI，-174.0 至 374.9）或 ER（MD，84.2；95% CrI，-35.3 至 206.4），与对照组相比，显著改善了 MWD（以米计）。长期随访时，与对照组相比，无任何治疗方法能显著改善 MWD。不良事件和生活质量的报告不一致，无法进行荟萃分析。偏倚风险分别为 4、24 和 18 项试验低、中、高。
这项网络荟萃分析表明，SET 和 ER+SET 在中期（<2 年）改善 MWD 方面是有效的，但超过这一时间则不然。间歇性跛行需要持久的治疗方法。
