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. 2016 Mar 11;2016(3):CD011033. doi: 10.1002/14651858.CD011033.pub3

Beigi 2014.

Methods Study design: RCT parallel group
Participants Country: Iran
Nº patients: 30 (14 in folic acid group and 16 in placebo group)
Setting: community
Mean age: 39; 42 years in folic acid group and 36 years in placebo group
Gender: all male
Inclusion criteria: negative history of hypertension, diabetes mellitus, ischaemic heart disease, cerebrovascular disease, collagen vascular disease or vasculitis
Exclusion criteria: quote "surgical sympathectomy or any sort of vascular bypass; using aspirin, calcium channel blocker, B6 or B12; stop smoking during the study and have not compliance of being treated. Also, patients with hypercoagulative state due to inherited thrombophilia (factor V Leiden, A202120G prothrombin variant, acquired activated protein C resistance, protein C and S deficiency, antithrombin deficiency"
Interventions Treatment:
Folic acid group: oral 5 mg folic acid tablet (by Jallinus Pharmacy, Tehran, Iran)
Placebo group: oral placebo with the same colour, size, weight and box (by Amin Pharmacy, Isfahan, Iran)
Duration of treatment: 1 day ‐ a single dose of folic acid or placebo
Follow‐up: 6 months
Outcomes Primary: Major and minor amputations
Notes Conflict of Interest: none declared
The study authors reported the following regarding a link between homocysteine levels and Buergers disease: quote "At the beginning of the study, homocysteine level was higher than normal in 19 patients (63%). There was a significant decrease in homocysteine level during 6 months in folic acid group (P < 0.001), but there was no change in the placebo group."
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computerised randomisation
Allocation concealment (selection bias) Low risk There was a person responsible for allocation concealment; codified using computerised randomisation, only revealed at the end of the trial
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Double blind
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Doctor responsible for outcome assessment assessed the patients at the start and at the end of treatment, but was not responsible for drug administration
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Study without losses to follow‐up
Selective reporting (reporting bias) High risk Did not describe the development of rest pain or ischaemic ulcers after the treatment
Other bias High risk Participants without critical ischaemia were eligible, resulting in low chances to be amputated. Conflict of interest: none declared.