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Paclitaxel-Based Devices for the Treatment of PAD: Balancing Clinical Efficacy with Possible Risk

  • Anna K. Krawisz
  • Eric A. SecemskyEmail author
Vascular Disease (M Weinberg, Section Editor)
  • 46 Downloads
Part of the following topical collections:
  1. Topical Collection on Vascular Disease

Abstract

Purpose of review

Paclitaxel-based endovascular devices have become the standard of care in symptomatic, medication-refractory peripheral artery disease (PAD) and in critical limb ischemia (CLI). This review examines the data on the efficacy and safety of these devices relative to standard balloon angioplasty (PTA) and bare metal stents (BMS).

Recent findings

Randomized controlled trials (RCTs) have found that peripheral devices coated with paclitaxel result in superior patency rates and decreased target lesion revascularization (TLR) compared with non-drug-coated devices. Recently, a meta-analysis of randomized controlled trials unexpectedly reported an increase in mortality in patients treated with paclitaxel-coated devices (PCDs), resulting in the pausing of ongoing trials and a warning of safety from the FDA. Observational data that has been published since this time has not supported this safety concern.

Summary

PAD is a common disease that severely impacts quality and length of life. PCDs are a promising therapy for patients with PAD, offering a more effective and durable intervention when compared with traditional PTA/BMS. A meta-analysis of RCTs identified a signal of harm with these devices which has now been replicated by the FDA. However, there is significant missing data from the trials analyzed by the meta-analysis and FDA, no plausible mechanism linking paclitaxel to death, and no correlation between paclitaxel dose and mortality. Analyses in observational data have found no safety signal. An FDA panel evaluating the validity of this late-mortality signal recently adjourned, emphasizing that the available data is incomplete. PCDs will remain on the market, and an active discussion is underway for developing an approach for improved post-market surveillance, device-labeling, and cause of death adjudication.

Keywords

Paclitaxel Endovascular Peripheral artery disease Drug-coated balloon Drug-eluting stent Meta-analysis 

Notes

Compliance with Ethical Standards

Conflict of Interest

Anna K. Krawisz declares no potential conflicts of interest.

Eric A. Secemsky reports grants and modest consulting fees given by Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Smith Center for Outcomes Research in Cardiology, Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Division of Cardiology, Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA

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