1
|
Weiss BG, Spiegel JL, Becker S, Strieth S, Olzowy B, Bertlich M, Fořt T, Mejzlik J, Lenarz T, Ihler F, Canis M. Randomized, placebo-controlled study on efficacy, safety and tolerability of drug-induced defibrinogenation for sudden sensorineural hearing loss: the lessons learned. Eur Arch Otorhinolaryngol 2023; 280:4009-4018. [PMID: 36881166 PMCID: PMC10382375 DOI: 10.1007/s00405-023-07896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Disturbance of cochlear microcirculation is discussed as final common pathway of various inner ear diseases. Hyperfibrinogenemia causing increased plasma viscosity is a possible factor for a critical reduction of cochlear blood flow that might lead to sudden sensorineural hearing loss (SSHL). The aim was to determine the efficacy and safety of drug-induced defibrinogenation by ancrod for SSHL. METHODS Double-blind, randomized, placebo-controlled, multicenter, parallel group, phase II (proof-of-concept) study (planned enrollment: 99 patients). Patients received an infusion of ancrod or placebo (day 1) followed by subcutaneous administrations (day 2, 4, 6). Primary outcome was the change in pure tone audiogram air conduction average until day 8. RESULTS The study was terminated early due to slow recruiting (31 enrolled patients: 22 ancrod, 9 placebo). A significant improvement of hearing loss was registered in both groups (ancrod: - 14.3 dB ± 20.4 dB, - 39.9% ± 50.4%; placebo: - 22.3 dB ± 13.7 dB, - 59.1% ± 38.0%). A statistically significant group-difference was not detected (p = 0.374). Placebo response of 33.3% complete and 85.7% at least partial recovery was observed. Plasma fibrinogen levels were reduced significantly by ancrod (baseline: 325.2 mg/dL, day 2: 107.2 mg/dL). Ancrod was tolerated well, no adverse drug reaction was of severe intensity, no serious adverse events occurred. CONCLUSION Ancrod reduced fibrinogen levels that support its mechanism of action. The safety profile can be rated positively. Since the planned number of patients could not be enrolled, no efficacy conclusion can be drawn. The high rate of placebo response challenges clinical trials for SSHL and needs to be considered in future investigations. Trial registrations This study was registered in the EU Clinical Trials Register, EudraCT-No. 2012-000066-37 at 2012-07-02.
Collapse
Affiliation(s)
- Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Bernhard Olzowy
- HNO-Zentrum Landsberg am Lech, Ahornallee 2a, 86899, Landsberg am Lech, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Marchioninistr. 15, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Tomáš Fořt
- FORTMEDICA s.r.o., ORL Modřany, Poliklinika Modřany, Soukalova 3355, 143 00, Prague 4, Czech Republic
| | - Jan Mejzlik
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
2
|
Kostal M, Drsata J, Bláha M, Lánská M, Chrobok V. Rheopheresis in treatment of idiopathic sensorineural sudden hearing loss. J Otolaryngol Head Neck Surg 2017; 46:50. [PMID: 28662721 PMCID: PMC5492286 DOI: 10.1186/s40463-017-0228-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/21/2017] [Indexed: 12/18/2022] Open
Abstract
Backround Only few therapeutic options exist for patients with refractory sudden idiopathic sensorineural hearing loss (SISHL). Little is known about the efficacy of second-line therapies. Rheopheresis seems to be an effective therapeutic possibility. Methods Between 2012 and 2015, 106 patients with SISHL were enrolled in the study, of whom 52 were refractory to initial treatment. As salvage therapy, these patients were offered either 3 sessions of rheopheresis (33 pts) or intratympanic steroid treatment through MicroWick application (19 pts). Pure tone audiometry was performed at diagnosis, at the 1st month and the 1st year during the follow-up. Results Patients in the rheopheretic arm had higher hearing loss than in the MicroWick arm (81% vs. 52%, p = 0.04). In spite of this, there was a significant improvement for patients in the rheopheretic arm (27% of hearing loss reduction, p < 0.001) after the 1st month and this remained unchanged during the 1st year, while no improvement was seen in the MicroWick arm (0% of hearing loss reduction, p = 0.424). We found no predictive factor for steroid-failure in first-line therapy. Older age (p = 0.003), presence of vertigo (p = 0.006) and more profound initial hearing loss (p < 0.001) were identified as negative prognostic markers. Conclusion Rheopheresis can be used as a potentially effective and safe salvage therapy for patients with cortico-refractory SISHL.
Collapse
Affiliation(s)
- Milan Kostal
- 4th Department of Internal Medicine, University Hospital Hradec Kralove Charles University, Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic.
| | - Jakub Drsata
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove Charles University, Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic
| | - Milan Bláha
- 4th Department of Internal Medicine, University Hospital Hradec Kralove Charles University, Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic
| | - Miriam Lánská
- 4th Department of Internal Medicine, University Hospital Hradec Kralove Charles University, Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove Charles University, Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic
| |
Collapse
|
4
|
Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
6
|
Abstract
The aetiology of acute hearing loss is mostly idiopathic like sudden sensorineural hearing loss and rarely infectious or vascular. Several studies and meta-analyses of pharmacotherapy are reviewed: In chronic tinnitus there is no indication for pharmacotherapy; sometimes a possible psychosomatic comorbidity has to be treated with psychopharmaceutical agents. Despite a low level of evidence treatment with steroids and initially plasma expanding infusions is recommended for acute tinnitus if there is no spontaneous remission. Intratympanic steroid therapy can be used as an alternative if there is severe hearing loss together with tinnitus.
Collapse
|
8
|
Plaza G, Durio E, Herráiz C, Rivera T, García-Berrocal JR. [Consensus on diagnosis and treatment of sudden hearing loss. Asociación Madrileña de ORL]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:144-57. [PMID: 21112580 DOI: 10.1016/j.otorri.2010.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 08/09/2010] [Accepted: 09/03/2010] [Indexed: 12/19/2022]
Abstract
Idiopathic sudden sensorineural hearing loss is an unexplained unilateral hearing loss with onset over a period of less than 72 hours, without other known otological diseases. We present a consensus on the diagnosis, treatment and follow-up of this disease, designed by AMORL, after a systematic review of the literature from 1966 to June 2010. Diagnosis of sudden sensorineural hearing loss is based on mandatory otoscopy, acoumetry, tonal audiometry, speech audiometry, and tympanometry. After clinical diagnosis is settled, and before treatment is started, a full analysis should be done and an MRI should be requested later. Treatment is based on systemic corticosteroids (orally in most cases), helped by intratympanic doses as rescue after treatment failures. Follow-up should be done at day 7, with tonal and speech audiometries, and regularly at 15, 30, and 90 days after start of therapy, and after 12 months. By consensus, results after treatment should be reported as absolute dBs recovered in pure tonal audiometry, as improvement in the recovery rate in unilateral cases, and as improvement in speech audiometry.
Collapse
Affiliation(s)
- Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|