Benzo-pyrones for controlling lymphedema of the limbs

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Benzo-pyrones for controlling lymphedema of the limbs

Postby patoco » Sun May 20, 2007 12:51 pm

We hear so much in the lymphedema world ab out benzo-pyrones
(flavanoids) and how they help reduce and/or control lymphedema.
Sometimes, we are even told taht there have been studies done that
verify their effectiveness. I ran across this study in 2004 that
reviewed numerous some of these studies and the validity of the info
from them. One of the reviewing participants was Dr. Peter Mortimer,
th well respected lymphedema doctor in the UK. Interesting.


Benzo-pyrones for reducing and controlling lymphoedema of the limbs.

Cochrane Database Syst Rev. 2004


Lymphoedema is the accumulation of excess fluid in the
body caused by obstruction of the lymphatic drainage mechanisms. It
can be caused by a number of factors, including congenital
predisposition, parasitic infection or surgery. Lymphoedema is chronic
and progressive and affects a significant proportion of the
population. The standard treatment regimes include compression
hosiery, skin care and exercise. The use of drugs in treatment,
particularly benzo-pyrones, has gained favour over the last ten years.
Benzo-pyrones, originally developed for use in vascular medicine, are
prescribed to reduce vascular permeability and thus the amount of
fluid forming in the subcutaneous tissues. Advocates for this
treatment method believe that, as a result of reducing filtration, the
drugs have some beneficial effect on pain and discomfort in the
swollen areas. Proponents also claim that these drugs increase
macrophage activity, encouraging the lysis of protein, which in turn
reduces the formation of fibrotic tissue in the lymphoedematous limb.

To assess the effectiveness of benzo-pyrones compared to
placebo or to different benzo-pyrones in reducing limb volume, pain
and discomfort in lymphoedematous limbs. To assess the effect of benzo-
pyrones on the quality of affected tissues and on the patient's
quality of life and, finally, to establish the incidence of adverse


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.

Types of studies considered for review were randomised controlled trials testing Paroven, coumarin, Venastat, Cyclo 3 Fort or Daflon versus placebo (with both groups having or not having standard physical treatment

Eligibility for inclusion was confirmed by two blinded reviewers who
screened the papers independently using a checklist of criteria
relating to the randomisation and blinding of the trial. Both
reviewers extracted data from the eligible studies using a data
extraction form.

Overall, 15 trials were included that evaluated the role of benzo-pyrones. Three trials of oxerutin were found. Each tested the drug over 6 months using the same dose of drug against placebo. Two were crossover trials and one a parallel group trial with a total number of 127 participants and data available for only 81 of them.

There were insufficient data provided in any of the trials to
calculate the per cent reduction or increase in baseline excess limb
volume. Standard deviations or confidence intervals and the numbers in
the groups at the different stages of the trial were missing for all
the data in two of the reports and for much of the data in the third,
making any attempt at meta-analysis impossible.One trial testing Cyclo
3 Fort (approved name) over 3 months was found and involved 57
patients but provided insufficient data to allow a proper analysis of
its findings. A single trial of Daflon (approved name) was found,
lasting 6 months and involving 104 participants; once again there was
insufficient information provided in the report to reach a conclusion
about the effectiveness of the drug.

Three trials of coumarin combined with troxerutin were found and
tested two different doses of the drug against each other with no
placebo, however, numbers of participants in the trial groups and
baseline data were not provided. Eight trials of coumarin were
identified. Two of the reports were confirmed as reporting the same
trial and a further trial potentially also referred to the same trial
but this was unconfirmed. A further two papers appeared to refer to
the same trial but this was not confirmed. Three trials involved the
same researcher. Five studies were conducted in India or China and
they added anti-filarial dia or China and they added anti-filarial
drugs to the interventions tested. The numbers of participants
withdrawn and the numbers included in the analyses in all these trials
were not extractable; the reporting of outcome measures in most of the
trials was not clear.

Loprinzi's 1999 trial in the USA reported the conduct of the trial and
its findings with more detail, however, its conclusions were very much
at odds with the findings of the other trials, finding that no
difference was observed between those on the active preparation
(coumarin) and placebo in any of the outcomes under investigation.
This trial also reported a case of hepato-toxicity in a patient
receiving the active preparation.

Meta-analysis was not performed due to the poor quality of the trials. It is not possible to draw conclusions about the effectiveness of Benzopyrones in reducing limb volume, pain, or discomfort in lymphoedematous limbs from these trials.

Plain language summary
Currently there is not enough evidence from research to show that
benzo-pyrones are either beneficial or unhelpful in reducing

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. ... frame.html


For info on exactly what benzoprone are:


Benzopyrones and Flavonoids ... eatmen.htm

Lymphedema and Homeopathy ... opathy.htm





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