Pentoxifylline for sickle-cell disease

OBJECTIVE: To review the use of pentoxifylline for the prevention and treatment of acute vasoocclusive episodes (VOEs) in sickle-cell disease (SCD). DATA SOURCES: Searches of MEDLINE (1965-April 2000), International Pharmaceutical Abstracts (1970-April 2000), and Science Citation Index Expanded (1989-April 2000) were performed using the key search terms sickle-cell disease, pentoxifylline, oxypentifylline, and Trental. DATA SYNTHESIS: Patients with SCD commonly suffer from painful VOEs. Pentoxifylline may be useful in this condition due to its ability to increase red blood cell deformability and inhibit platelet aggregation. Laboratory evidence, an animal model, and case reports suggest a benefit, but available clinical studies are methodologically poor, and data analysis is often inappropriate or absent. Limited data suggest that pentoxifylline is beneficial for treatment of a VOE in progress, but no data exist demonstrating a reduction in the number of VOEs with chronic pentoxifylline therapy. CONCLUSIONS: Documentation of the efficacy of pentoxifylline for VOE prevention and treatment of SCD is poor; further studies are needed before its routine use is recommended.