Pentoxifylline is NOT Used to Treat Multiple Sclerosis
Pentoxifylline has no established role in the treatment of multiple sclerosis and should not be used for this indication. Despite theoretical rationale based on its TNF-α inhibitory properties, clinical trials in MS patients have consistently failed to demonstrate efficacy.
Evidence from Clinical Trials in MS Patients
The available clinical data directly contradict any therapeutic benefit:
A 24-month study of 14 MS patients in progression phase showed disease worsening in 12 of 14 patients (86%) despite pentoxifylline treatment at doses of 2,400-3,200 mg/day, with deterioration documented by clinical, MRI, or visual evoked potential criteria 1
An 18-month randomized study comparing interferon plus pentoxifylline (800 mg/day) versus interferon alone in 18 patients with relapsing-remitting MS found no statistical improvement in EDSS or Neurological Score scales in either group 2
A pilot study of 20 MS patients found no convincing or consistent effect of pentoxifylline on cytokine levels, adhesion molecules, T-cell activation, or clinical measures 3
Why the Theoretical Rationale Failed
While pentoxifylline does inhibit TNF-α production in vitro and prevented experimental allergic encephalomyelitis (EAE) in rat models 4, this did not translate to human MS:
Laboratory studies confirmed that pentoxifylline reduced in vitro TNF-α production in MS patients taking the drug, yet clinical outcomes remained poor 1
The disconnect between immunological effects and clinical efficacy suggests that TNF-α inhibition alone is insufficient to modify MS disease course 3
Approved Indications for Pentoxifylline
Pentoxifylline's only established indication is intermittent claudication, where it provides marginal benefit at best:
The American College of Cardiology/American Heart Association guidelines classify pentoxifylline as Class IIb (may be considered as second-line alternative to cilostazol) but explicitly state its effectiveness is "marginal and not well established" 5, 6, 7
Standard dosing is 400 mg orally three times daily with meals 7
Common Pitfall to Avoid
Do not confuse pentoxifylline's use as adjunctive therapy in mucosal leishmaniasis (where it showed benefit in combination with antimony compounds) 5 with any potential role in MS—these are completely unrelated conditions with different pathophysiological mechanisms.