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Iloprost and cisaprost for Raynaud's phenomenon in progressive systemic sclerosis

Scleroderma is a connective tissue disease causing fibrosis and commonly affects the skin and internal organs such as the GI tract, lungs, kidney and heart.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for pulmonary arterial hypertension within their licensed indications: a systematic review and economic evaluation

Pulmonary arterial hypertension (PAH) is a diverse group of diseases with similar pathophysiology and clinical presentation. It is characterised by a progressive increase of pulmonary vascular resistance, leading to right ventricular heart failure and premature death. PAH can occur with no identifiable cause. This was previously referred to as primary pulmonary hypertension (PPH) but was renamed as idiopathic PAH (IPAH). PAH is also commonly associated with various conditions including connective tissue disease (CTD-APAH) and congenital heart disease (CHD). Symptoms of PAH include dyspnoea (breathlessness), fatigue, chest pain, syncope (fainting) and oedema, which can result in loss of capacity to perform exercise and eventually activity of daily living. It therefore has a devastating impact on both the quality and duration of patients' life. PAH is a rare disease with an estimated incidence of two to four cases per million per year, which approximates 100 to 200 new cases in England and Wales per year.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2009

Prostanoids for treating people with severe peripheral arterial disease of the legs

People with severely narrowed arteries of the lower limbs may suffer rest pain, ulcers, or gangrene, and this problem is called critical limb ischaemia. There is no option other than amputation for patients who present with critical limb ischaemia and who are unsuitable for rescue or reconstructive intervention of the arteries. The question is whether specific drugs such as prostanoids reduce mortality and progression of the disease, including amputations, more than placebo or other treatments. This review of 20 trials did not find any conclusive evidence that prostanoids provided long‐term benefit. Prostanoids seem to have efficacy regarding rest‐pain relief and ulcer healing. Iloprost may also have favourable results regarding major amputations. The more frequently reported adverse events when using prostanoids were headache, facial flushing, nausea, vomiting and diarrhoea

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for pulmonary arterial hypertension within their licensed indications: a systematic review and economic evaluation

This review concluded that all five drugs added to supportive care were more effective than supportive care alone. There was insufficient evidence to compare the effectiveness of different drugs or to assess combinations of drugs. The review was generally well conducted and the authors’ conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

PGE1 and other prostaglandins in the treatment of intermittent claudication: a meta-analysis

In intermittent claudication, pharmacologic drugs and invasive measures are indicated in patients who do not benefit from exercise training. To evaluate the therapeutic role of prostaglandins (PGs), especially of prostaglandin E1 (PGE1), for this indication, the author performed a meta-analysis of all published prospective, randomized, controlled clinical studies in which descriptive sample statistics of the pain-free walking distance (PFWD) and the maximum walking distance (MWD) were available. In total, 9 studies with PGE1 and 4 studies with other PGs (beraprost, iloprost, AS-013) that met these selection criteria could be analyzed. In patients treated with PGE1 (n = 344), PFWD increased significantly (p < 0.001) more (+107%) than in patients treated with other PGs (n = 402; +42%) or placebo (n = 470; +24%). Similar results were also found for the MWD. Side effects were significantly (p < 0.001) fewer with PGE1 therapy than with other PGs (14.0% vs 30.8% of patients). In conclusion, PGE1 proved to be the most effective and best tolerated of the PGs evaluated.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Pharmacological treatment for Buerger's disease

Buerger's disease is characterized by recurring progressive inflammation and clotting in small and medium arteries and veins of the hands and feet. Its cause is unknown, but it is most common in men with a history of tobacco use. It is responsible for ulcers and extreme pain in the limbs of young smokers. In many cases, mainly in patients with the most severe form, there is no possibility of improving the condition with surgery, and therefore, drugs (pharmacological agents) are used. These can be pharmacological agents, such as cilostazol, clopidogrel, and pentoxifylline, or medicine derivatives of prostacyclin and prostaglandin, which redirect blood flow and improve the circulation in affected areas, and theoretically, help to heal ulcers and relieve rest pain. This review assessed the effectiveness of pharmacological agents in the treatment of patients with Buerger's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Drugs for Pulmonary Arterial Hypertension: Comparative Efficacy, Safety, and Cost-Effectiveness [Internet]

The objective of this therapeutic review is to conduct a systematic review to assess the comparative efficacy and safety and to determine the cost-effectiveness of drug therapies for the treatment of pulmonary arterial hypertension (PAH) in adults.

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: March 2015
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Prostanoids for intermittent claudication

Intermittent claudication (IC) is a symptom of lower limb ischaemia that results from peripheral arterial disease (PAD). It is evident as muscle pain (ache, cramp, numbness or sense of fatigue) in the leg muscles that occurs during exercise and is relieved by a short period of rest. Prostaglandin E1 (PGE1) and prostacyclin (PGI2), also known as prostanoids, are vasoactive drugs used in PAD to reduce arterial insufficiency. The aim of this review was to evaluate the effects of prostanoids in patients with IC. We identified 18 randomised studies with a total of 2773 participants, of which four studies compared the effects of PGE1 versus placebo. Overall, there was insufficient high quality evidence to suggest that PGE1 improves walking distances in people with IC. There was also a lack of evidence to determine if PGE1 was more effective than laevadosin, naftidrofuryl or L‐arginine. Evidence on the efficacy of prostacyclin was inconclusive. Results suggest that, compared with PGE1, prostacyclin may be associated with an increased occurrence of side effects including headache, diarrhoea and facial flushing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Exercise for reducing intermittent claudication symptoms

Intermittent claudication is a cramping leg pain that develops when walking and is relieved with rest. It is caused by inadequate blood flow to the leg muscles because of atherosclerosis (fatty deposits restricting blood flow through the arteries). People with mild‐to‐moderate claudication are advised to keep walking, stop smoking and reduce cardiovascular risk factors. Other treatments include antiplatelet therapy, pentoxifylline or cilostazol, angioplasty (inserting a balloon into the artery to open it up) and bypass surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Pentoxifylline for intermittent claudication

Atherosclerosis, or hardening of the arteries, results in narrowing and blockage of the arteries and can reduce the blood supply to the legs, causing peripheral arterial disease. Intermittent claudication (IC) is a cramp‐like pain felt in the leg muscles that is brought on by walking and is relieved by standing still or resting. Pentoxifylline is a drug that is used to relieve IC while improving people's walking capacity. It decreases blood viscosity and improves red blood cell flexibility, promoting microcirculatory blood flow and increasing oxygen in the tissues. This review looked at all available evidence from randomised controlled trials on the efficiency of pentoxifylline for treatment of IC.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Children, Young People and Adults

For the purposes of this guideline, head injury is defined as any trauma to the head other than superficial injuries to the face. Head injury is the commonest cause of death and disability in people aged 1–40 years in the UK. Data for head injury are recorded in the Hospital Episode Statistics (http://www.hscic.gov.uk/hes). Each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury. Between 33% and 50% of these are children aged under 15 years. Annually, about 200,000 people are admitted to hospital with head injury. Of these, one-fifth have features suggesting skull fracture or have evidence of brain damage. Most patients recover without specific or specialist intervention, but others experience long-term disability or even die from the effects of complications that could potentially be minimised or avoided with early detection and appropriate treatment.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: January 2014
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Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis

Study found that ivacaftor is a clinically effective treatment for patients with cystic fibrosis and the G551D mutation; however, the high cost of ivacaftor may be a barrier to its uptake. Ivacaftor resulted in significant improvements compared with placebo for all but one of the subgroups investigated; further research should prioritise investigating its long-term effectiveness.

Health Technology Assessment - NIHR Journals Library.

Version: March 2014
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Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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Drugs for Pulmonary Arterial Hypertension — Project Protocol [Internet]

CADTH will undertake a systematic review to compare the efficacy and safety of new and existing drug therapies for pulmonary arterial hypertension (PAH), and will examine their cost-effectiveness. The review will include drug therapies that are available in Canada (epoprostenol, treprostinil, bosentan, ambrisentan, macitentan, sildenafil, tadalafil) and one for which the clinical development program is advanced but is not yet approved for the treatment of PAH in Canada (riociguat).

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: February 2014
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Lower Limb Peripheral Arterial Disease: Diagnosis and Management [Internet]

Lower limb peripheral arterial disease (known in the document as peripheral arterial disease, PAD) is a marker for an increased risk of potentially preventable cardiovascular events even when it is asymptomatic. If it becomes symptomatic it can lead to significant impairment of quality of life through limiting mobility and in its more severe manifestations may lead to severe pain, ulceration and gangrene and is the largest single cause of lower limb amputation in the UK.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2012
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A Systematic Review and Economic Evaluation of Cilostazol, Naftidrofuryl Oxalate, Pentoxifylline and Inositol Nicotinate for the Treatment of Intermittent Claudication in People with Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a condition in which there is blockage or narrowing of the arteries that carry blood to the legs and arms. It is estimated to affect around 4.5% of people aged between 55 and 74 years within the UK. The most common symptom of PAD is intermittent claudication (IC), characterised by pain in the legs on walking that is relieved with rest.

Health Technology Assessment - NIHR Journals Library.

Version: December 2011
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The clinical effectiveness and cost-effectiveness of treatments for idiopathic pulmonary fibrosis: a systematic review and economic evaluation

The study found that few interventions for idiopathic pulmonary fibrosis have any statistically significant effect, and identified a lack of studies on palliative care approaches. Few direct comparisons of treatments were identified; an indirect comparison was performed through network meta-analysis, but the results should be interpreted with caution.

Health Technology Assessment - NIHR Journals Library.

Version: March 2015
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Comparative Effectiveness Review Methods: Clinical Heterogeneity [Internet]

The Agency for Healthcare Research and Quality (AHRQ) funded the RTI International—University of North Carolina at Chapel Hill Evidence-based Practice Center to determine best practices for addressing clinical heterogeneity in systematic reviews (SRs) and comparative effectiveness reviews (CERs). These best practices address critiques from patients, clinicians, policymakers, and others who assert that SRs typically focus on broad populations and, as a result, often lack information relevant to individual patients or patient subgroups.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: September 2010
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Prophylactic intraoperative antithrombotics in open infrainguinal arterial bypass surgery (IABS): a systematic review

Unfractionated heparin (UFH) is used intraoperatively as antithrombotic by most vascular surgeons worldwide during infrainguinal bypass surgery (IABS) to reduce the risk of peroperative and early graft thrombosis. To reduce the harmful side effects of UFH (bleeding complications, HIT) and to reduce peroperative and early graft failure, other pharmaceuticals have been suggested for IABS. A systematic review was performed using MEDLINE, EMBASE and Cochrane databases. Only 9 studies on IABS and intraoperative antithrombotic use were eligible for review. Between studies heterogeneity was high and investigated study populations were often of small size. No study was retrieved comparing UFH to no-UFH. Dextran, human antithrombin and iloprost showed no beneficial effect compared to UFH alone for patency, mortality and morbidity. Low molecular weight heparin (LMWH) has potential benefits compared to UFH, but a statistically significant effect could not be demonstrated from the current review. The use of UFH during IABS to prevent intraoperative graft thrombosis has not been proven in randomized clinical trials. Dextran, human antithrombin and iloprost showed to be of no added beneficial effect for the patient compared to UFH alone. Data on the use of LMWH instead of UFH are promising, but no statistically significant benefit could be reproduced from literature. Results from a recent Cochrane review were favourable for LMWH, but it appeared that included data were not complete in that review. Randomized controlled trials are required for intra-operative use of antithrombotics and to improve peroperative and early patency after IABS.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

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