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To the Editor: In discussing medical treatment of PAD, Dr Hankey and colleagues¹ state that "a meta-analysis of 8 [randomized controlled trials] involving 2702 patients demonstrated that cilostazol improved maximum walking distance and pain-free walking distance," citing Thompson et al.² However, in that study, the effect size was small, with increases of 50% and 67% in maximum walking distance and pain-free walking distance, respectively. Stated differently, if a patient could walk to first base before experiencing claudication, then with the addition of cilostazol, with its potential toxicity and at a cost in our pharmacy of $467.78 per month, he or she could round first and make it part of the way to second base.

Addressing effect size and cost data could help clinicians improve decision-making beyond a simple assertion of a drug's effectiveness for treating the condition.

Financial Disclosures: None reported.

Thomas E. Finucane, MD
tfinucane@jhmi.edu
Geriatric Center
Johns Hopkins Bayview Medical Center
Baltimore, Md

1. Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA. 2006;295:547-553. FREE FULL TEXT 2. Thompson PD, Zimet R, Forbes WP, Zhang P. Meta-analysis of results from eight randomized, placebo controlled trials, on the effect of cilostazol on patients with intermittent claudication. Am J Cardiol. 2002;90:1314-1319. FULL TEXT | WEB OF SCIENCE | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296:41.

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