Benzo-pyrones for reducing and controlling lymphoedema of the limbs

 

Abstract

Background

Lymphoedema is the accumulation of excess fluid in the body caused by obstruction of the lymphatic drainage mechanisms. Treatment with Benzo-pyrones is thought to reduce fluid forming in the subcutaneous tissues and reduce pain and discomfort of the affected area.

Objectives

To assess the effectiveness of benzo-pyrones compared to placebo in the management of lymphoedema.

Search methods

We searched the Cochrane Breast Cancer Group register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4,2003), MEDLINE, EMBASE, CINAHL, UnCover, PASCAL, SIGLE, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and The International Society of Lymphology congress proceedings.

Selection criteria

Randomised controlled trials comparing Benzo-pyrones with placebo.

Data collection and analysis

Trials were selected for eligibility and tested for quality by two blinded reviewers who independently extracted data. Meta-analysis was not performed due to the poor quality of the trials.

Main results

Fifteen trials were included. Three oxerutin trials tested the same dose over 6 months against placebo and included a total of 127 participants (data were available for 81). There were insufficient data from these to calculate the per cent reduction or increase in baseline excess limb volume.

One trial testing Cyclo 3 Fort (approved name) was found (57 participants) but insufficient data was provided to allow a proper analysis of its findings. A single trial of Daflon (approved name) was found (104 participants) but this also provided insufficient information to reach a conclusion about the effectiveness of the drug. Three trials of coumarin combined with troxerutin were found which tested two different doses of the drug against each other with no placebo, however participant numbers and baseline data were not provided. Eight trials of coumarin were identified. Two of these reported the same trial and the other potentially also referred to the same trial but this could not be confirmed. A further two papers also appeared to refer to the same trial but again this was unconfirmed.

Five studies added anti-filarial drugs to the interventions tested. Participant data could not be extracted and the reporting of outcome measures in most was unclear. Loprinzi's 1999 trial was reported in more detail but its conclusions were very much at odds with other findings.

Authors' conclusions

It is not possible to draw conclusions about the effectiveness of Benzopyrones in the management of lymphoedema from the current available trials.

 

Plain language summary

Benzopyrones for reducing and controlling lymphoedema of the limbs

Lymphoedema is an accumulation of excess fluid, mainly in the arms and legs. It can occur in several ways: from birth; as a result of a parasitic infection; or as a complication of cancer surgery. The most common treatments are compression hosiery (e.g. bandaging, sleeves, etc.), skin care and exercise. The drugs commonly known as benzo-pyrones have been prescribed to prevent the fluid leakage and collection which characterises lymphoedema. This review found that there was not enough good quality evidence to draw conclusions about whether benzo-pyrones are useful either in reducing lymphoedema or the pain and discomfort associated with it.

 

摘要

背景

使用Benzopyrones 來減少和控制肢體的淋巴水腫

淋巴水腫是因淋巴回流系統的阻塞造成多餘淋巴液在組織的堆積所造成的。使用 Benzopyrone 治療被認為可減少皮下組織淋巴液生成進而減少受淋巴水腫影響區域的痛苦和不適。

目標

比較Benzopyrones與安慰劑對淋巴水腫的治療效果

搜尋策略

我們搜尋了Cochrane乳腺癌小組登錄(至2003年9月)， Cochrane 對照組控制的臨床試驗中心(Cochrane圖書館，2003年4月發行)， MEDLINE， EMBASE， CINAHL，UnCover，PASCAL，SIGLE等資料庫。參考書目來自英國淋巴學協會，國家研究登錄(NRR)和國際淋巴學行動協會。

選擇標準

比較Benzopyrones與安慰劑的隨機控制試驗。

資料收集與分析

選擇合格的試驗後，由兩位不知情的評論者獨立的進行資料頡取及統合，由於試驗的品質不佳，因此並未進行統合分析。

主要結論

搜尋結果共包含十五個臨床試驗， 三個oxerutin試驗測試了同一藥量使用6個月與安慰劑的比較，其中包括127個受試者(81個可用的數據)，由這些有限的資料無法計算出肢體多出容積增加或減少的百分比。 我們發現一個Cyclo 3 Fort(核准的名字)的試驗(有57個受試者)，但研究結果資料的不足造成無法進行適當的分析。我們也發現一個有關Daflon(批准的名字)的單一試驗(有104個參加者)，但研究結果也不足以提供藥物是否有明確的療效。 有三個coumarin結合troxerutin的試驗測試二種藥劑量，在沒有安慰劑的情況下互相比較，然而這些試驗未提供受試者人數和原始數據。 另外有8個coumarin的報告，其中2個報告來自同一試驗而另外6個則都來自另一個試驗，但是這些資訊是無法確認的。 有五個研究加上了反絲蟲的藥物治療。 但無法取得參加者數據，而且試驗結果的報告幾乎都不明確。 Loprinzi在1999年的試驗則有詳細的報告，但是它的結論卻與其他研究結果明顯的意見分歧。

作者結論

從當前可用的試驗來看，Benzopyrones對淋巴水腫的明確治療效果是沒有定論的。

翻譯人

本摘要由中山醫學大學附設醫院蘇峻弘翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

這篇文章是研究Benzopyrones 是否能減少和控制肢體的淋巴水腫 淋巴水腫是因多餘淋巴液在組織的堆積所造成的，最主要發生在手臂與腿部，病因包括先天的，寄生蟲感染或癌症術後的併發症，最常見的治療是彈性壓迫(使用繃帶，袖套等)，皮膚照護和運動。 藥物治療方面，一般認為Benzopyrones可減少淋巴液漏出及堆積進而減少淋巴水腫。 研究回顧發現沒有足夠的優良證據來證實Benzopyrones 是否可以減少淋巴水腫及它所帶來的痛苦和不適。