MedicalResearch.com Interview with:
Farzin Fakhry, MD PhD Candidate
Depts. of Epidemiology & Radiology
Erasmus MC Rotterdam, the Netherlands and
Myriam Hunink MD, PhD Professor
Professor of Radiology and Clinical Epidemiology
Erasmus University Medical Center Rotterdam
Adjunct Professor of Health Decision Science
Harvard T.H. Chan School of Public Health, Boston
Medical Research: What is the background for this study? What are the main findings?
Response: Intermittent claudication is the classical symptomatic form of peripheral arterial disease (PAD) and affects approximately 20-40 million people worldwide. These patients experience significant functional disability resulting in a sedentary lifestyle and reduced quality of life. In the Endovascular Revascularization And Supervised Exercise (ERASE) study we compared a combination therapy of endovascular revascularization plus supervised exercise versus the recommended care of supervised exercise only as first-line treatment for patients with intermittent claudication.
Results from the ERASE study showed that after one year follow up patients in both groups showed significant improvements in their treadmill walking distance and disease specific quality of life. Yet, patients receiving the combination therapy had more rapid and significantly greater improvement in their walking performance and disease specific quality of life compared to the patients following a supervised exercise program only.
Medical Research: What should clinicians and patients take away from your report?
Response: Results from the ERASE study showed that both supervised exercise and a combination therapy of endovascular revascularization and supervised exercise are effective first-line management strategies for intermittent claudication. The big advantage of the combination therapy beyond supervised exercise only is that it results in more rapid improvement in claudication symptoms and leads to significantly greater improvement in treadmill walking performance and disease specific quality of life up to one year follow up.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Studies with long-term follow up are needed to determine whether the significant difference between the groups in favor of the combination therapy will also be durable beyond one year follow up. In addition cost-effectiveness analysis are required to determine whether the incremental benefit of the combination therapy as demonstrated in the ERASE study will also be cost-effective compared to supervised exercise only.
Farzin Fakhry, Sandra Spronk, Lijckle van der Laan, Jan J. Wever, Joep A. W. Teijink, Wolter H. Hoffmann, Taco M. Smits, Jerome P. van Brussel, Guido N. M. Stultiens, Alex Derom, P. Ted den Hoed, Gwan H. Ho, Lukas C. van Dijk, Nicole Verhofstad, Mariella Orsini, Andre van Petersen, Kristel Woltman, Ingrid Hulst, Marc R. H. M. van Sambeek, Dimitris Rizopoulos, Ellen V. Rouwet, M. G. Myriam Hunink. Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication. JAMA, 2015; 314 (18): 1936 DOI:10.1001/jama.2015.14851
Farzin Fakhry, MD PhD Candidate, & Myriam Hunink MD, PhD Professor (2015). Revascularization Plus Exercise Improves PAD Symptoms More Quickly Than Exercise Alone MedicalResearch.com