1
|
Damaraju V, Sehgal IS, Muthu V, Prasad KT, Dhooria S, Aggarwal AN, Agarwal R. Efficacy and safety of doxycycline versus iodopovidone for pleurodesis through an intercostal tube in malignant pleural effusions: a randomized trial. Support Care Cancer 2023; 31:454. [PMID: 37428348 DOI: 10.1007/s00520-023-07932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The search for an inexpensive agent for chemical pleurodesis in malignant pleural effusion (MPE) continues. We aimed to compare the efficacy and safety of iodopovidone versus doxycycline for pleurodesis in MPE. METHODS We randomized consecutive subjects with recurrent symptomatic MPE (1:1) to undergo pleurodesis with either doxycycline or iodopovidone administered through an intercostal tube. The primary outcome was the success rate of pleurodesis at 30 days. The secondary outcomes were the time to pleurodesis, chest pain (assessed using visual analog scale [VAS]) after pleurodesis, and complications (hypotension, acute respiratory failure, empyema). RESULTS We randomized 52 and 58 subjects to receive either doxycycline or iodopovidone. The mean (standard deviation [SD]) age of the study population (51% women) was 54.1 (13.6) years. Lung cancer (≥ 60%) was the most common underlying cause of MPE. We observed a similar frequency of success in the doxycycline vs. the iodopovidone group (complete response: 43 (82.7%) vs. 46 (79.3%) subjects; partial response: 7 (13.5%) vs. 10 (17.2%) subjects; p = 0.3). The mean (SD) time to pleurodesis was 1.5 (1.9) days and 1.9 (5.4) days in the doxycycline and iodopovidone groups, respectively. While the VAS for chest pain was significantly higher with iodopovidone (mean [SD] VAS: doxycycline, 31.9 [20.9]; iodopovidone, 41.3 [21.8]; p = 0.017), it did not reach the minimal clinically important difference. The complication rates were similar between the two groups. CONCLUSION Iodopovidone was not superior to doxycycline for pleurodesis in MPE. TRIAL REGISTRATION NUMBER/DATE: clinicaltrials.gov (NCT02583282) / October 22, 2015.
Collapse
Affiliation(s)
- Vikram Damaraju
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, 160012, Chandigarh, India.
| |
Collapse
|
2
|
Agmy G, Adam MF, El Sagheir SA, Mahmoud MA. Transthoracic sonographic scores in evaluating the success of different scelerosing modalities in patients with malignant pleural effusion. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Malignant pleural effusions (MPE) mostly arises from metastases to the pleura from other sites. Management of malignant effusions aims to palliate dyspnea and prevent the reaccumulation of pleural fluid to improve patients’ quality of life. Pleurodesis is the most common palliative treatment for patients with refractory MPE. This study was carried out to evaluate the performance of transthoracic sonographic (TUS) scores (pleural sliding and pleural adherence score) in predicting the success of pleurodesis by different modalities in patients with malignant pleural effusion. One hundred malignant pleural effusion patients were enrolled to an interventional clinical trial from September 2019 to April 2021 for palliative management of dyspnea. Pleurodesis for palliative treatment of dyspnea was done either spontaneously by the intercostal chest tube or by a sclerosing agent such as tetracycline solution or tetracycline poudrage or iodopovidine. Patients were randomly allocated to one of these four groups where each group included 25 patients. Transthoracic ultrasound was performed at baseline, and 1 month after pleurodesis and the lung sliding score and pleural adherence score were evaluated.
Results
Majority of patients (78%) had high baseline lung sliding score (7-8). Post pleurodesis only 11.4% had high scores (p<0.001), also the mean lung sliding score decreased significantly in comparison to the baseline values (p˂ 0.001) in the spontaneous, tetracycline solution, tetracycline poudrage, and iodopovidine groups (7.04 ± 1.02 vs. 4.85 ± 1.60, 7.28± 0.98 vs. 4.48± 1.75, 7.20±0.96 vs. 4.44 ± 1.45, 7.04±0.93 vs. 3.35±1.81, respectively). Iodopovidine pleurodesis group in comparison to the other modalities showed the highest pleural adherence score (12.64 ± 2.98) and absent lung sliding in 72.7% of cases and 70 % success rate. Pleural adherence score at cut off ≥ 12 showed 92.75% sensitivity, 89.47% specificity, 92.1 accuracy, and 0.911 area under the curve (AUC) for predicting successful pleurodesis.
Conclusion
TUS scores is a feasible, bedside, and accurate method to detect the outcome of pleurodesis. Iodopovidone was more effective than tetracycline solution, tetracycline poudrage, and spontaneous pleurodesis.
Trial registration
ClinicalTrials.gov. NCT04074902. Registered on 29 August 2019
Collapse
|
3
|
Muthu V, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Agarwal R. Iodopovidone pleurodesis for malignant pleural effusions: an updated systematic review and meta-analysis. Support Care Cancer 2021; 29:4733-4742. [PMID: 33515303 DOI: 10.1007/s00520-021-06004-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chemical pleurodesis is an important option for palliation in malignant pleural effusion (MPE). OBJECTIVES To evaluate the status of iodopovidone for pleurodesis in MPE. METHODS We performed a systematic review of PubMed and EMBASE databases to identify studies evaluating the role of iodopovidone for pleurodesis in MPE. We calculated the pooled success rate of iodopovidone pleurodesis from observational studies and the risk ratio (RR) of successful pleurodesis (compared to other agents) from randomized controlled trials (RCTs). We pooled the data using the random-effects model. We also assessed the safety of iodopovidone. RESULTS We included 26 studies (n = 1132, 15 observational, and 11 RCTs) in our review. The pooled success rate (95% confidence interval [CI]) from 15 observational studies (n = 648) was 90% (86-94). The efficacy rate of iodopovidone was similar with either tube thoracostomy or thoracoscopy. Eleven (n = 484) RCTs compared the efficacy of iodopovidone with other agents (especially bleomycin and talc). We found a similar success rate of iodopovidone compared to other agents with a pooled RR (95% CI) of 0.99 (0.91-1.08). The most frequent adverse event was chest pain. No hypo or hyperthyroidism, or visual disturbance was encountered in any study. There were no deaths attributed to iodopovidone use. CONCLUSIONS Iodopovidone is a safe and effective agent for pleurodesis in the management of MPE. Further confirmation is required since the available evidence is limited by the low quality and small sample size of the included studies.
Collapse
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
| |
Collapse
|
4
|
Garzón JC, Edward Vinck E, Carolina Cárdenas D, Jaime Téllez L. Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients. J Cardiovasc Thorac Res 2020; 12:328-333. [PMID: 33510883 PMCID: PMC7828754 DOI: 10.34172/jcvtr.2020.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs).
Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging.
Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively.
Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.
Collapse
Affiliation(s)
- Juan Carlos Garzón
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Eric Edward Vinck
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Diana Carolina Cárdenas
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| | - Luis Jaime Téllez
- Department of Thoracic Surgery and Lung Transplant, Fundación Cardioinfantil, Bogota, Colombia
| |
Collapse
|
5
|
Magdy KM, Hieba EG. Outcome of ultrasound-guided, single session pleurodesis in malignant pleural effusion. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chemical pleurodesis is frequently indicated to relieve symptoms imposed by large/recurrent malignant pleural effusion (MPE). Traditionally, a drain is left in the pleural space till the cessation of fluid accumulation before pleurodesis. Chest ultrasound can detect an amount of pleural fluid as less as 50 ml and can confirm apposition of the pleural surfaces which is required for successful pleurodesis. This work assessed the efficiency and safety of ultrasound-guided, single-session pleurodesis in cases with MPE.
Results
Seventeen of the patients completed a 2-month follow-up. The technique demonstrated a high success rate (88.2%). The mean duration from the start of pleural drainage till pleurodesis was 1.65 ± 0.70 h ranging from 1 to 3 h. A duration of 2.5 h or less was statistically proposed as a cutoff value not to exceed to predict success (sensitivity 100%, specificity 100%). The mean time for total hospital stay related to pleurodesis was 9.88 ± 3.12 h (range 4–12 h). No complications attributed to the procedure were recorded. Pleural Adherence Score and Absent Sliding Score (ASS) had a highly statistically significant correlation (p value < 0.001).
Conclusions
An ultrasound-guided completion of the process of pleurodesis in a single session with a shorter duration of pleural fluid drainage and shorter hospital stay (can be done on a day-care basis) is efficient, safe, and cost-effective. This technique is strongly recommended to replace the traditional practice of keeping the indwelling pleural drain for several days waiting for the cessation of pleural fluid reaccumulation. An ultrasound-derived ASS can be used as early as day 1 and day 15 to confirm pleural adherence and to expect the outcome of pleurodesis.
Collapse
|
6
|
Hatata EA, Daabis RG, El Sabaa BM, Baess AI, Abd El-Rahman IA. Doxycycline poudrage: An old agent for a new technique. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
El-Kolaly RM, Abo-Elnasr M, El-Guindy D. Outcome of pleurodesis using different agents in management of malignant pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
8
|
Pleural fluid CRP, LDH, and pH as predictors of successful pleurodesis in malignant pleural effusions. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
9
|
Mohammed EA, Eisa SA, Abdelghaffar Hibah NA. Efficacy of tranexamic acid as pleurodesis agent in malignant pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|