In patients with idiopathic dilated cardiomyopathy, pentoxifylline significantly improved functional class (P=0.01) and left ventricular ejection fraction (P=0.03) compared to placebo.
RCT (n=39)
Double-blind
randomized
No
Does pentoxifylline improve functional class, exercise tolerance, and left ventricular function in patients with idiopathic dilated cardiomyopathy already treated with ACE inhibitors and carvedilol?
The addition of pentoxifylline to standard heart failure therapy including carvedilol and ACE inhibitors improves symptoms and left ventricular function in patients with idiopathic dilated cardiomyopathy.
p-value: p=0.01 for functional class, 0.03 for LVEF
BACKGROUND: We previously reported beneficial effects of pentoxifylline, a xanthine-derived agent known to inhibit the production of tumor necrosis factor-alpha, in patients with idiopathic dilated cardiomyopathy treated with diuretics, digoxin, and ACE inhibitors. Since then, 3 large clinical trials showed important clinical benefits of beta-blockers in this population. Therefore, we designed the present study to establish whether in patients with heart failure already receiving treatment with ACE inhibitors and beta-blockers, the addition of pentoxifylline would have an additive beneficial effect. METHODS AND RESULTS: In a single-center, prospective, double-blind, randomized, placebo-controlled study, 39 patients with idiopathic dilated cardiomyopathy were randomized to pentoxifylline 400 mg TID (n=20) or placebo (n=19) if they had a left ventricular ejection fraction <40% after 3 months of therapy with digoxin, ACE inhibitors, and carvedilol. Primary end points were New York Heart Association functional class, exercise tolerance, and left ventricular function. Patients were followed up for 6 months. Five patients died (3 in the placebo group). Patients treated with pentoxifylline had a significant improvement in functional class compared with the placebo group (P:=0.01), with an increment in exercise time from 9.5+/-5 to 12.3+/-6 minutes (P:=0.1). Left ventricular ejection fraction improved from 24+/-9% to 31+/-13%, P:=0.03, in the treatment group. CONCLUSIONS: In patients with idiopathic dilated cardiomyopathy, the addition of pentoxifylline to treatment with digoxin, ACE inhibitors, and carvedilol is associated with a significant improvement in symptoms and left ventricular function.
Skudicky et al. (Tue,) conducted a rct in Idiopathic dilated cardiomyopathy (n=39). Pentoxifylline vs. Placebo was evaluated on New York Heart Association functional class, exercise tolerance, and left ventricular function (p=0.01 for functional class, 0.03 for LVEF). In patients with idiopathic dilated cardiomyopathy, pentoxifylline significantly improved functional class (P=0.01) and left ventricular ejection fraction (P=0.03) compared to placebo.