defibrotide and Arterial-Occlusive-Diseases

The authors provide evidence for the efficacy of the buflomedil-pentoxifylline-defibrotide combination for treatment of lower limb chronic obstructive arterial disease, Fontain stage II. Improvement of walking autonomy obtained with these agents ranged from 50 to 100% in 29 of 36 patients (relative frequency = 0.80).

Topics: Aged; Aged, 80 and over; Arterial Occlusive Diseases; Chronic Disease; Drug Therapy, Combination; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Pentoxifylline; Polydeoxyribonucleotides; Pyrrolidines; Vasodilator Agents

In a random double-blind study versus placebo, 60 ambulatory patients with peripheral occlusive disease of the lower limbs and claudicatio intermittens (Leriche's stage 2), were treated for 60 days with defibrotide (400 mg b.i.d., oral, n = 30) or placebo (n = 30). Patients in the defibrotide group received additional treatment with the same drug at the reduced rate of 400 mg once daily for another 120 days for maintenance (total treatment duration 180 days). All patients were assessed at intake and 60 days for relative and absolute walking distance (RWD and AWD) in a standard treadmill test and for the Winsor Index (WI) at rest and after exercise; patients of the defibrotide treatment group were retested in the same way at 90-180 days. In a subgroup of patients (defibrotide = 11, placebo = 12), blood samples were obtained for the assessment of whole blood and plasma viscosity at intake and after 60 days of treatment. These samples could not be collected properly in the remaining cases, for technical reasons. At day 60, we compared the effects of the two treatments on physical performance: mean (SE) values of RWD were for defibrotide 148 (9.7) and 179 (12.4) m in basal and post-treatment conditions, respectively, and 209 (16.2) and 212 (17.1) m for placebo. Similar changes were observed for AWD: for defibrotide 206 (13.4) and 241 (15.2) m and for placebo 270 (22.9) and 272 (23.1) m. The mean changes were significantly larger with defibrotide: for RWD + 33 (7.1) vs. + 0.3 (3.8) m (p < 0.01) and for AWD + 34 (9.2) and -2 (6.6) m (p < 0.01). The overall gain of walking distance after maintenance therapy with the reduced defibrotide dosage amounted to approximately + 50% over basal (after 180 days). Blood and plasma viscosity improved in patients on defibrotide but the change fell short of statistical significance versus placebo. All findings confirm the potential usefulness of defibrotide in the treatment of peripheral arterial disease, at the same time encouraging further studies of the involved mechanisms of action.

Topics: Aged; Arterial Occlusive Diseases; Blood Viscosity; Double-Blind Method; Female; Fibrinolytic Agents; Hemorheology; Humans; Intermittent Claudication; Leg; Male; Middle Aged; Peripheral Vascular Diseases; Placebos; Platelet Aggregation Inhibitors; Polydeoxyribonucleotides; Walking

Defibrotide is a polydeoxyribonucleotide drug known to modulate the endothelial cell release of t-PA, PAI, and PGI-2 and to improve blood flow and perfusion. A double-blind, multicenter, placebo-controlled, dose comparison study was carried out to test the long-term efficacy and safety of defibrotide in patients with PAD (Leriche stage 2). Informed patients suffering from PAD were enrolled, and after a 15-day washout period were randomly allocated in a double-blind fashion to one of the three following treatments: defibrotide 400 mg (1 cps) b.i.d. for 6 months, defibrotide 400 mg o.d., or placebo. Absolute walking distance (AWD, treadmill) and ankle-arm pressure ratio (Winsor Index, WI) were evaluated at the beginning and after 30, 90, and 180 days after therapy. Two hundred twenty seven patients were recruited and 193 patients were included in the final analysis (800 mg: 67; 400 mg: 60; placebo: 66). All treatments brought about an increase in AWD placebo = +17%; 400 mg = +47%, 800 mg = +52%); however, patients treated with defibrotide exhibited a significantly better AWD at the end of treatment in comparison with placebo (p less than 0.01). AWD was not significantly different in the 400-mg and 800-mg groups. There was a trend indicating a possible improvement of WI after defibrotide, with higher WI in 800-mg patients in comparison with placebo (p less than 0.05). However, this difference was partly due to a decrease in arterial blood pressure elicited by the drug. The tolerability in all groups was optimal. These results indicate that orally administered defibrotide exerts symtomatic benefit in PAD patients and daily doses of 400 or 800 mg seem to be equivalent.

Topics: Administration, Oral; Adult; Aged; Anticoagulants; Arterial Occlusive Diseases; Double-Blind Method; Female; Fibrinolytic Agents; Hemodynamics; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Physical Endurance; Polydeoxyribonucleotides; Prospective Studies

This was a random double-blind study versus placebo designed to assess the effectiveness and tolerability of defibrotide in patients with chronic peripheral vascular disease (PVD), Leriche stage II. A total of 20 male outpatients (mean age 58.8 years) were selected and treated with placebo for 2 weeks (run-in period), and then allocated randomly to treatment with defibrotide (200 mg/day, intramuscular, n = 10) or matched placebo (n = 10) for 90 days. Before intake and at 15, 30, 60, and 90 days of treatment, each patient received a Doppler ultrasound examination of the lower limbs, and the residual perfusion index (Winsor) was calculated at rest and immediately after a symptom-limited treadmill test. Absolute walking distance was measured in addition. Blood samples were taken for routine laboratory tests before intake and at 30 and 90 days of treatment. All patients completed the trial without adverse effects; no meaningful alterations of laboratory test returns were detected. Patients receiving defibrotide showed a significant increase of the Winsor index after exercise at 90 days versus basal (mean 0.47 +/- 0.04 vs. 0.43 +/- 0.05, p less than 0.05), and a parallel increase of walking distance (basal 288 +/- 42.3 m vs. 368 +/- 46.6 at 60 days, p less than 0.05, and 407 +/- 64.3 m at 90 days, p less than 0.01). No improvement was seen in the placebo group. These preliminary results suggest that defibrotide may prove beneficial to patients with PVD; further studies are needed to find the most appropriate dosage regime.

Topics: Arterial Occlusive Diseases; Clinical Trials as Topic; Double-Blind Method; Fibrinolytic Agents; Humans; Male; Middle Aged; Physical Exertion; Pilot Projects; Polydeoxyribonucleotides; Random Allocation

Topics: Arterial Occlusive Diseases; Aspirin; Chronic Disease; Epoprostenol; Fatty Acids, Monounsaturated; Humans; Methacrylates; Polydeoxyribonucleotides; Pyridines; Thromboxane A2; Thromboxane-A Synthase

In a pilot study, defibrotide was administered to 22 patients with arterial occlusive disease of the lower limbs (mean age 59 years; range 48-71 years), of whom 12 were Fontaine 2nd stage and 10 Fontaine 3rd stage. In the first group, treatment enabled significant improvement in the walking distance (580 +/- 95 vs 220 +/- 65 m; M +/- SD; p less than 0.001), even 15 days after discontinuation of therapy (445 +/- 110 m; p less than 0.05). In 3rd stage patients, treatment caused reasonable reduction of pain, with elimination of resting pain in 4 patients. Both groups underwent no modification of Doppler velocimetry and Winsor index, while photoplethysmography in 8 patients at 2nd- and in 3 patients at 3rd-stage showed improvement at the end of treatment. There were no modifications of hepatic, renal, hemopoietic and hemocoagulative functions. Beta-thromboglobulin showed a statistically significant reduction (62 +/- 10 vs 116 +/- 18 ng/ml; M +/- SEM; p less than 0.001), from 2 weeks after the first dose until 15 days after discontinuation of therapy. Defibrotide proved particularly efficacious in Fontaine 2nd-stage patients, showing its suitability for treating the stages of occlusive atherosclerotic disease at which collateral circulation can still be activated.

Topics: Aged; Arterial Occlusive Diseases; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Pilot Projects; Polydeoxyribonucleotides; Rheology

Topics: Animals; Arterial Occlusive Diseases; Dogs; Fibrinolytic Agents; Humans; Mice; Polydeoxyribonucleotides; Rabbits; Rats; Thrombophlebitis

Twenty-nine patients with atherosclerotic obliterative vascular disorder and 9 cases of Buerger's disease were treated with 600 mg defibrotide daily for 10 days and then three times weekly for 3 months. The response to therapy was evaluated from hemostatic parameters, venostasis test (cuff test), treadmill testing, and radionuclide arteriography. We observed increased pain-free intervals in daily life and during treadmill testing. There was also a significantly higher response in the cuff test and improved perfusion as seen by radionuclide arteriography.

Topics: Adult; Arterial Occlusive Diseases; Arteriosclerosis; Exercise Test; Female; Fibrinolytic Agents; Humans; Leg; Male; Middle Aged; Polydeoxyribonucleotides; Thromboangiitis Obliterans