Efficacy of L-propionyl carnitine in the treatment of chronic critical limb ischemia

Objective: To compare the therapeutic benefits of L-propionyl carnitine (LPC) with those of pentoxifylline in the clinical treatment of patients with chronic critical limb ischaemia. Design: Randomised, single-blind study. Patients: 188 patients, 85 with a recent (within the previous 15 days) reduction in pain-free walking distance (PWD), 59 with rest pain lasting for ≥2 weeks, and 44 patients with skin ulcers that had appeared during the previous 15 days. Interventions: Intravenous infusion with LPC 1.2 g/day or pentoxifylline 1.2 g/day. In both groups, patients also received calcium heparin 25 000 U/day (12 500U twice daily) subcutaneously. Treatment duration was 2 weeks. Main Outcome Measures and Results: With both treatments, an increase in the PWD, a reduction in the use of analgesics for pain relief and a reduction in the diameter (in cm) of skin ulcers were observed; all changes were significant versus baseline for both groups. However, a statistically significant difference was observed between the results obtained with LPC and those obtained with pentoxifylline, which was in favour of LPC. Mean PWD increased by 78% in the LPC group vs 30% in the pentoxifylline group (p < 0.001), mean pain score decreased by 83 vs 46% (p < 0.001), and mean ulcer size decreased by 48 vs 25% (p<0.001). Conclusions: LPC, which has already been shown to produce beneficial effects in the treatment of the chronic phase of peripheral vascular disease, was also found in this study to have greater effects in delaying disease progression than pentoxifylline, a drug that has been extensively tested for this indication. LPC, therefore, appears to be a promising treatment option in patients with peripheral arterial disease and should be further explored in large randomised, long-term controlled trials.