Eschewing opioids, physicians look to repurposed drugs for venous leg ulcers

MAUI, HAWAII — Clinicians should avoid prescribing opioids when treating venous leg ulcers, a speaker at Maui Derm said.

Robert Kirsner, MD, PhD, chair of the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine, illustrated his point by referencing a study of nearly 700 patients with venous leg ulcers.

“We looked at the size of the patients’ wounds, how long their wounds were there, recorded the gender of each patient and whether or not they took opioids,” he said. “When we controlled for these factors, we found was that nonclosure of a venous leg ulcer was related to larger wound area, longer wound duration and use of opioids. This and other studies suggest that opioids impair wound healing,” he said.

Kirsner said physicians are reaching for repurposed drugs like aspirin, pentoxifylline and statins to help patients with venous leg ulcers.

“Aspirin has some of the best data on this subject,” Kirsner said. “The studies were not huge, and patients used 300 mg per day, which is more than the standard United States dose, but the patients showed improved venous ulcer healing and experienced delayed time to wound recurrence. If a patient can take aspirin, the cost and convenience of [300 mg] daily dose makes aspirin a reasonable add-on.”

Another repurposed drug that Kirsner encouraged clinicians to consider for venous leg ulcers was pentoxifylline. He showed data that indicated the standard regimen — 400 mg given three times a day — was more effective than placebo for complete ulcer healing or a significant improvement in that healing. ll.

However, Kirsner cautioned that pentoxifylline is both costly and can be difficult to obtain.

“Start with a low dose of low pentoxifylline and work up to the higher dose,” he said.
If you can get a patient who can tolerate a higher dose, you’ll get a much better result in treating the wound.”

Finally, Kirsner pointed to a study that showed that compared to placebo, patients with diabetes and venous leg wounds who were given statins had a lower amputation risk and experienced faster healing of small wounds.

“Statins have a clear effect for not just lowering lipids, but for venous leg ulcers as well,” he said. – by Janel Miller

Reference: Kirshner R. Wound healing advances in 2020. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.

Disclosure: Healio Primary Care could not confirm Kirsner’s relevant financial disclosures at the time of publication.