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Balaban U, Kara E, Mahmoud SH, Ozcebe OI, Demirkan K. Examination of drug removal profiles in patients undergoing therapeutic plasma exchange: A retrospective study. Ther Apher Dial 2024. [PMID: 39009957 DOI: 10.1111/1744-9987.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/24/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) eliminates disease-contributing substances but may also affect drug concentrations. This study aimed to assess the prevalence of prescription drugs removable via TPE by reviewing patient medication histories. METHODS A retrospective, single-center study was conducted from January 1, 2021 to December 31, 2022. The study included 244 patients undergoing 1087 TPE sessions. Drugs prescribed to patients on TPE days were categorized as "yes" (probably removable), "maybe" (possibly removable), and "no" (unlikely removable) regarding their removability via TPE. RESULTS Among 3966 prescriptions, 556 (14.0%) were analyzed, with 21.8%, 36.5%, and 41.7% falling into the "yes," "maybe," and "no" categories for removability. Although only 14.0% were categorized, 83.6% of patients received at least one analyzable drug. Among them, 83.8% had at least one potentially removable drug. CONCLUSION Real-world data highlights the need for caution in drug treatments during TPE to ensure optimal therapeutic outcomes, particularly for specific drugs.
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Affiliation(s)
- Ugur Balaban
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Emre Kara
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sherif Hanafy Mahmoud
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Osman Ilhami Ozcebe
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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2
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Pu Y, Zhao Y, Qi Y, Liu Y, Zhang M, Xiao X, Lyu H, Meng J, Zhu H, Xu K, Han W, Zhao M. Multi-centers experience using therapeutic plasma exchange for corticosteroid/tocilizumab-refractory cytokine release syndrome following CAR-T therapy. Int Immunopharmacol 2024; 130:111761. [PMID: 38422769 DOI: 10.1016/j.intimp.2024.111761] [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: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
The chimeric antigen receptor T (CAR-T) cell therapy significantly enhances the prognosis of various hematologic malignancies; however, the systemic expansion of CAR-T cells also gives rise to severe cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS). Despite the successful application of corticosteroids and tocilizumab in alleviating severe CRS in most patients, there are still individuals who experience life-threatening CRS without responding to the aforementioned therapies. In our retrospective cohort, we conducted an analysis of clinical and laboratory parameters, including inflammatory cytokines, in 17 patients from three centers who underwent therapeutic plasma exchange (TPE) for refractory CRS with or without ICANS following CAR-T products treatment. Our findings demonstrate a significant improvement in both clinical symptoms and laboratory parameters subsequent to TPE treatment. The rapid decrease in temperature and levels of inflammatory indexes indicates the remarkable scavenging efficacy of TPE against cytokine storm following CAR-T therapy. In conclusion, TPE may serve as a valuable and safe adjunct to corticosteroids and tocilizumab in the management of severe CRS resulting from CAR-T cell infusion. We eagerly await further prospective studies to validate this finding.
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Affiliation(s)
- Yedi Pu
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Yifan Zhao
- The First Central Clinical College of Tianjin Medical University, Tianjin 300380, China
| | - Yuekun Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Yang Liu
- Department of Bio-therapeutic, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Meng Zhang
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Xia Xiao
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Hairong Lyu
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Juanxia Meng
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Haibo Zhu
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China.
| | - Weidong Han
- Department of Bio-therapeutic, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China.
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3
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Holt K, Dulgar K, Reinert JP. Examining an Interaction Between Plasma Exchange and Apixaban Resulting in an Acute Ischemic Stroke. J Pharm Technol 2024; 40:45-49. [PMID: 38318256 PMCID: PMC10838543 DOI: 10.1177/87551225231207273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Objective: Therapeutic drug monitoring is not routinely considered necessary in patients undergoing plasma exchange; however, it is possible for serum concentrations of select medications to be impacted by this procedure. Case: We describe a 50-year-old patient who presented to our facility with new onset aphasia and right-sided weakness. Despite presenting with a National Institute of Health Stroke Severity (NIHSS) score of 23, the patient did not receive fibrinolytic therapy due to his being anticoagulated with apixaban for atrial fibrillation. The patient instead underwent an emergent thrombectomy which resulted in a post-operative Thrombolysis in Cerebral Infarction (TICI) score of 3. The patient had a significant past medical history including numerous previous strokes necessitating assistance with activities of daily living, atrial fibrillation, chronic kidney disease, and thrombocytopenic purpura, for which he was receiving twice weekly plasma exchange and immunomodulatory therapy. The patient's last plasma exchange session was approximately 24 hours prior to admission, leading us to hypothesize that the patient's plasma exchange may have been implicated in the removal of apixaban from the serum and precipitating a stroke. Discussion/Conclusions: Heterogeneity of data exists when evaluating the effect of plasma exchange on apixaban. Although the drug properties of apixaban, including its low volume of distribution and high plasma protein binding capacity, support the notion that it may be vulnerable to removal through plasma exchange, only one other case report has been published on this phenomenon.
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Affiliation(s)
- Katlyn Holt
- College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
| | - Katelyn Dulgar
- College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
| | - Justin P. Reinert
- College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH, USA
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4
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Tolou-Ghamari Z. Tacrolimus and Cyclosporin Pharmacotherapy, Detection Methods, Cytochrome P450 Enzymes after Heart Transplantation. Cardiovasc Hematol Agents Med Chem 2024; 22:106-113. [PMID: 37496131 DOI: 10.2174/1871525721666230726150021] [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: 11/26/2022] [Revised: 04/10/2023] [Accepted: 06/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Advances in organ transplantation were made after the discovery of the pure form of cyclosporine by Dr Jean Borel in the 1970s. In fact, in clinical practice achieving a delicate balance in circulating immunosuppressive necessitate focus on the difficult task of posttransplant therapeutic drug monitoring. OBJECTIVE The purpose of this study was to determine the pharmacologic properties of cyclosporine- tacrolimus, detection methods, and the effects on the activity of cytochrome P450 enzymes when prescribing the most efficient treatments in forms of polypharmacy for the recipients of heart transplantation. METHODS Scientific literature on the interactions of tacrolimus and cyclosporine with human cytochrome P450 enzymes was searched using PUBMED.Gov (https://pubmed.ncbi.nlm.nih.gov/), Web of Science, and Scopus. RESULTS Prescription immunosuppressive drugs based on polypharmacy accompanied by induction agents could result in hidden neurotoxicity and nephrotoxicity. A literature search shows that cyclosporine prescription with antihypertensives drugs needs close monitoring. Co-administration of tacrolimus and diltiazem or verapamil needs a decrease in the tacrolimus dose by 20-50%. Vigilant attention to the lowest possible statin dose is needed when coadministered with fluvastatin or pravastatin. Polypharmacy based on ticlopidine, clopidogrel, and cyclosporine or tacrolimus needs monitoring of immunosuppressive drug levels for several months. A prescription with clotrimazole or fluconazole needs close monitoring, and itraconazole or ketoconazole needs to reduce the initial dose by 50%. Combination with nefazodone needs to be avoided, and alternative drugs such as sertraline or citalopram could be prescribed in addition to further monitoring consideration. In prescription with phenytoin, the bound and free phenytoin levels need close monitoring. CONCLUSION Polypharmacy based on tacrolimus or cyclosporine needs vigilant therapeutic drug monitoring due to the cytochrome P450 enzymes associated with biochemical variables in metabolic pathways. Further attention to polypharmacy should be given to circulate drugs that could hide pharmacokinetics interactions associated with infections, malignancies, chronic kidney disease, and rejection after organ transplantation.
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Affiliation(s)
- Zahra Tolou-Ghamari
- Deputy of Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Jacobs JW, Villalba CAF, Stendahl K, Tormey CA, Abels E. Immunity in the balance: Fatal disseminated adenovirus infection in a patient undergoing plasma exchange and immunosuppressive chemotherapy for anti-glomerular basement membrane disease. J Clin Apher 2023; 38:770-777. [PMID: 37698143 DOI: 10.1002/jca.22088] [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: 06/07/2023] [Revised: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
Anti-glomerular basement membrane (anti-GBM) disease (formerly known as Goodpasture's syndrome) is a rare autoinflammatory condition that affects the renal and/or pulmonary capillaries. The standard therapeutic regimen for anti-GBM disease involves therapeutic plasma exchange (TPE), cyclophosphamide, and corticosteroids to rapidly remove and inhibit autoantibody production and reduce organ inflammation. Herein we report an 82-year-old female who developed anti-GBM disease but expired despite therapy, secondary to multi-organ failure in the setting of disseminated adenovirus disease. We discuss the utility and potential adverse effect of daily TPE for a protracted course (ie, 10-14 days), the recommended TPE intensity in the 2023 American Society for Apheresis guidelines, updated from every-other-day TPE in the 2019 guidelines, despite no new data. We also highlight the potential for unusual infections to occur in these patients due to the profound immunosuppression, and discuss the importance of balancing immunosuppression to treat the disease with close surveillance of any potential opportunistic infections.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kristin Stendahl
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Abels
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
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6
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Neth BJ, Winters JL, Sairaj RT, Gharibi Loron A, Rahman M, Hirte R, Riviere-Cazaux C, Ruff MW, Burns TC. Plasma exchange as a tool for removal of bevacizumab: Highlighting application for urgent surgery. Neurooncol Pract 2023; 10:592-595. [PMID: 38009115 PMCID: PMC10666800 DOI: 10.1093/nop/npad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Background Bevacizumab is commonly used to manage cerebral edema associated with brain tumors. However, its long half-life poses challenges for patients requiring urgent surgery due to wound complications. We present a case of utilizing therapeutic plasma exchange (TPE) to remove bevacizumab in a patient with recurrent glioblastoma requiring urgent surgery. Methods A 58-year-old male with recurrent glioblastoma, IDH-wildtype, presented with clinical and radiographic concern for ventriculitis requiring urgent wound washout only 4 days after his last bevacizumab infusion. TPE was performed for 3 sessions after surgery using a centrifugation-based cell separator. Replacement fluids included normal serum albumin, normal saline, and fresh frozen plasma. Bevacizumab levels were quantified using an enzyme-linked immunoabsorbent assay before and after each TPE session. Results TPE effectively removed bevacizumab, enabling safe surgery without new complications. Plasma bevacizumab levels decreased from 1087.63 to 145.35 ng/mL (13.4% of original) by the end of the last TPE session. This decline is consistent with nearly 3 half-lives, which compares favorably to the expected timeline of natural decline given the 21-day half-life. Conclusions We report a complex clinical scenario of a patient requiring urgent wound washout 4 days after last bevacizumab infusion for CNS infection. Surgery was successfully performed without new complications with use of TPE to remove bevacizumab immediately following surgery. This case highlights the feasibility of this approach, which may be utilized effectively in patients requiring surgery after having recently received bevacizumab.
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Affiliation(s)
- Bryan J Neth
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Masum Rahman
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Renee Hirte
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael W Ruff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Terry C Burns
- Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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7
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Seah V, Sreeharan T, Kocic D, Reuter SE, Girgis L, Marriott DJE, Stocker SL. Effect of Therapeutic Plasma Exchange on Itraconazole Pharmacokinetics: A Case Study. Ther Drug Monit 2023; 45:129-132. [PMID: 36730858 DOI: 10.1097/ftd.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/08/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT The authors present the case of a 34-year-old male patient who underwent therapeutic plasma exchange (TPE) for amyopathic dermatomyositis. Immunosuppression resulted in Aspergillus lentulus pulmonary infection , requiring treatment with super bioavailable-itraconazole. Therapeutic itraconazole concentrations were attained after 2 weeks of treatment after dose adjustments. Interestingly, a substantial reduction in plasma itraconazole concentration was observed during TPE, which was attributed to an insufficient delay between the dosing of itraconazole and TPE initiation. Furthermore, there was an increase in plasma concentration post-TPE, which presumably reflects the redistribution of itraconazole from peripheral compartments back into plasma. This was confirmed by sampling of the TPE plasmapheresate, which revealed that changes in plasma concentration overestimated itraconazole clearance. These findings highlight that the pharmacokinetics of itraconazole are altered during TPE, which should be considered when timing drug administration and obtaining plasma concentrations.
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Affiliation(s)
- Vincent Seah
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney
| | - Thulashigan Sreeharan
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney
- Sydney School of Pharmacy, The University of Sydney, Sydney
| | - Danijela Kocic
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney
- Department of Chemical Pathology and Clinical Pharmacology, SydPath, St Vincent's Hospital, Sydney
| | - Stephanie E Reuter
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide; and
| | - Laila Girgis
- Department of Rheumatology, St Vincent's Hospital, Sydney, Australia
| | - Deborah J E Marriott
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney
| | - Sophie L Stocker
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney
- Sydney School of Pharmacy, The University of Sydney, Sydney
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8
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Binns TC, Sostin N, Tormey CA. State of the Evidence: Drug Removal via Apheresis. Transfus Med Rev 2023; 37:16-20. [PMID: 36604194 DOI: 10.1016/j.tmrv.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Therapeutic apheresis refers to a diversity of procedures in which specific hematologic components (e.g., plasma, erythrocytes, leukocytes, etc.) with pathological associations are removed from circulation (with possible replacement) in order to treat a variety of disease processes. As pharmacologic agents also circulate with these components, their removal is sometimes incidental, or in the scenario of drug toxicity, a therapeutic goal. The corpus of published manuscripts on this subject has grown immensely over the past few decades; however, the breadth of diseases, methods, and drugs that co-exist in this space make it challenging to generate generalizable evidence regarding drug removal via apheresis. This review discusses factors worth considering when interpreting literature-reported data on drug removal by apheresis with examples from several notable studies and highlights topics in need of evidential improvement and growth as our palette of therapeutic agents continues to expand.
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Affiliation(s)
- Thomas C Binns
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Nataliya Sostin
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
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Thomas M, Benfield J, Morales J. Case Report of Seronegative Cancer-Associated Retinopathy in a Patient with Small Cell Lung Carcinoma. Case Rep Oncol 2023; 16:791-796. [PMID: 37900796 PMCID: PMC10601748 DOI: 10.1159/000531624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/13/2023] [Indexed: 10/31/2023] Open
Abstract
Cancer-associated retinopathy (CAR) is a rare paraneoplastic syndrome characterized by autoimmune destruction of photoreceptor cells. It is associated with several tumor types, including small cell lung carcinoma (SCLC). Corticosteroids have been the mainstay treatment for CAR, although no therapeutic standard has truly been established. A 66-year-old female with significant smoking history and age-related macular degeneration (ARMD) presented with rapidly declining bilateral visual acuity. Ophthalmologic examination findings appeared consistent with the known diagnosis of ARMD but did not otherwise present a clear alternative etiology. Imaging with a computed tomography (CT) scan revealed a right hilar mass which was confirmed to be limited stage SCLC based on a subsequent biopsy and further imaging with a positron emission tomography/computed tomography (PET/CT) scan. Antibody testing was negative for anti-recoverin antibodies. The patient experienced a complete response to chemoradiation with cisplatin and etoposide; however, her ocular symptoms did not respond to a combined treatment approach with corticosteroids, plasmapheresis, and intravenous immunoglobulin (IVIG). While CAR represents a rare condition in SCLC, cases that are seronegative for anti-recoverin are even less common. Further, the diagnosis of CAR by ophthalmologic examination may be more challenging in patients with pre-existing ocular diseases, such as macular degeneration. Clinicians should have suspicion for paraneoplastic blindness in patients with known risk factors for malignancy, whose ocular symptoms are inconsistent with exam findings.
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Affiliation(s)
- Miles Thomas
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - John Benfield
- Internal Medicine, Carilion Clinic, Roanoke, VA, USA
| | - Joshua Morales
- Medical Oncology, Blue Ridge Cancer Care, Roanoke, VA, USA
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10
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Jaruratanasirikul S, Neamrat P, Jullangkoon M, Samaeng M. Impact of therapeutic plasma exchange on meropenem pharmacokinetics. Pharmacotherapy 2022; 42:659-666. [DOI: 10.1002/phar.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sutep Jaruratanasirikul
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
| | - Phangard Neamrat
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
| | - Monchana Jullangkoon
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
| | - Maseetoh Samaeng
- Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Hat Yai Thailand
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Mc Dermott S, Dargan C, Gonzalez Dominguez E, Music Aplenc L, Flatt T, Iqbal N. Therapeutic plasma exchange for multiorgan dysfunction among critically ill pediatric patients with leukemia: A single-institutional experience. J Clin Apher 2022; 37:367-375. [PMID: 35405029 DOI: 10.1002/jca.21983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) has well-documented applications in the adult population, outlined by the American Society for Apheresis (ASFA) 2019 guidelines. Limited data exist regarding the use of TPE in critically ill pediatric patients; however, these reports rarely include patients with oncological diseases. METHODS We highlight the use of TPE in the acute management of seven pediatric patients with leukemia treated at Children's Mercy Hospital ICU from 2015 to 2020, including TPE specifications, baseline and interval laboratory evaluation, and outcome measures. Analysis compared those who did (n = 4) and did not (n = 3) survive 30 days post-TPE. RESULTS Multiorgan failure (MOF) prompted the initiation of TPE in 85.7% of patients, 57.1% of whom were also diagnosed with hemophagocytic lymphohistiocytosis (HLH). Baseline laboratory evaluations prior to initiation of TPE were similar between the two groups. With subsequent TPE treatments, C-reactive protein (CRP) and lactic acid decreased. CRP and lactic acid following the last TPE treatment were significantly higher for those deceased 30 days post-TPE (P = .023 and .031, respectively). No TPE-associated adverse events necessitated discontinuation of TPE treatment. Several surviving patients required chemotherapy dose reductions or alterations. CONCLUSION Our cohort demonstrated MOF and HLH consistently as indications for TPE, currently ASFA category III indications (optimal role of apheresis is not yet established). Recognition of this treatment modality earlier in the clinical course for critically ill oncological patients may lead to the development of formal protocols that may result in earlier initiation of TPE and improved outcomes.
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Affiliation(s)
- Sarah Mc Dermott
- Department of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Chandni Dargan
- Department of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Lejla Music Aplenc
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Terrie Flatt
- Department of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Nazia Iqbal
- Department of Pediatric Hematology/Oncology/BMT, Children's Mercy Hospital, Kansas City, Missouri, USA
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12
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Baldwin I, Todd S. Therapeutic plasma exchange in the intensive care unit and with the critically ill, a focus on clinical nursing considerations. J Clin Apher 2022; 37:397-404. [PMID: 35385601 PMCID: PMC9539889 DOI: 10.1002/jca.21984] [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: 12/09/2021] [Revised: 01/31/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
Abstract
Therapeutic plasma exchange (TPE) is a blood purification technique removing antibodies and plasma proteins to modulate disease and promote recovery. The procedure has different methods, using a membrane or plasma separator with many elements similar to continuous renal replacement therapy (CCRT) in the Intensive Care Unit (ICU). These nursing knowledge and skill sets apply where ICU nurses are providing TPE with increasing need. However, different care models are also in place where TPE is the responsibility of apheresis and nephrology teams visiting the ICU. The plasma replacement volume and prescribing is aligned with published guidelines but is variable when critical illness overlays the primary indication for TPE. There are some important considerations for TPE with respect to anticoagulation, machine settings, prescribing, and associated nursing management. TPE can be performed concurrent with CRRT in acute situations using Y‐piece and valve connectors and is a new and recent advanced blood purification for the ICU.
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Affiliation(s)
- Ian Baldwin
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
| | - Sarah Todd
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria
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13
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Yaxley J, Scott T. Dialysis and Extracorporeal Therapies for Enhanced Elimination of Toxic Ingestions and Poisoning. Ther Apher Dial 2022; 26:865-878. [PMID: 35355407 DOI: 10.1111/1744-9987.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/16/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
Poisoning and toxic ingestions cause significant morbidity and mortality worldwide. Extracorporeal therapies such as dialysis, haemoperfusion and plasma exchange are selectively applied to patients with severe intoxications unresponsive to standard interventions and can be lifesaving. Extracorporeal therapies are a complex but fundamental aspect of the practice of nephrology. Without high-quality evidence to guide implementation, an understanding of toxicokinetics and the physiochemical principles of the enhanced elimination techniques is especially important. This review provides a comphrensive, user-friendly outline of the application of extracorporeal therapy in the poisoned patient.
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Affiliation(s)
- Julian Yaxley
- Department of Nephrology, Gold Coast University Hospital, Southport, Qld, Australia.,Department of Nephrology, Cairns Hospital, Cairns, Qld, Australia.,Department of Intensive Care Medicine, Gold Coast University Hospital, Southport, Qld, Australia
| | - Tahira Scott
- Department of Nephrology, Cairns Hospital, Cairns, Qld, Australia.,Department of Nephrology, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
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14
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Li H, Gao C, Lin L, Zhang G, Fan S, Hai X. Pharmacokinetics of cefoperazone/sulbactam in critically Ill thrombotic thrombocytopenic purpura patients undergoing therapeutic plasma exchange. J Clin Pharm Ther 2022; 47:1232-1239. [PMID: 35347732 DOI: 10.1111/jcpt.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Haitao Li
- Department of Hematology First Affiliated Hospital of Harbin Medical University Harbin China
| | - Chunlu Gao
- Department of Pharmacy First Affiliated Hospital of Harbin Medical University Harbin China
| | - Liwang Lin
- Department of Pharmacy First Affiliated Hospital of Harbin Medical University Harbin China
| | - Gensheng Zhang
- Department of Critical Care Medicine Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Shengjin Fan
- Department of Hematology First Affiliated Hospital of Harbin Medical University Harbin China
| | - Xin Hai
- Department of Pharmacy First Affiliated Hospital of Harbin Medical University Harbin China
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Keiner M, Dreller V, Klemm I, Lehmann H. [Accidental colchicine intoxication in a cross-breed dog]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:46-56. [PMID: 35235962 DOI: 10.1055/a-1696-3847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 2-year old cross-breed dog presented due to acute vomiting and progressive lethargy following ingestion of the owner's anti-gout medication (colchicine, 0.35 mg/kg) 1-3 hours prior to presentation.The dog developed signs of all 3 stages of colchicine poisoning (gastrointestinal phase, multi-organ phase, recovery phase) and the clinical course was complicated by the presence of multi-organ dysfunction syndrome (MODS) and numerous negative prognostic factors.This case report describes the clinical and laboratory effects of colchicine poisoning and represents the first successful treatment of an accidental colchicine ingestion in a dog in Europe.
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Affiliation(s)
- Miriam Keiner
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Vanessa Dreller
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Isabelle Klemm
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Hendrik Lehmann
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
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16
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Plasma exchange in the intensive care unit: a narrative review. Intensive Care Med 2022; 48:1382-1396. [PMID: 35960275 PMCID: PMC9372988 DOI: 10.1007/s00134-022-06793-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023]
Abstract
In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine.
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17
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Osborne JC, Brown CS, Peffley ND, Wittwer ED, Yalamuri SM. Phenytoin Pharmacokinetics During Venoarterial Extracorporeal Membrane Oxygenation and Plasma Exchange. Cureus 2021; 13:e17120. [PMID: 34527498 PMCID: PMC8434762 DOI: 10.7759/cureus.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/05/2022] Open
Abstract
Currently, there is minimal guidance to antiepileptic dose adjustment for a patient requiring either venoarterial (VA) extracorporeal membrane oxygenation (ECMO) or plasma exchange (PLEX) therapy, and to our knowledge, there are rare guidances for a patient requiring both. Given the dangers with non-therapeutic concentrations of phenytoin, it is critical for the intensive care unit (ICU) practitioner to understand how the pharmacokinetic parameters of phenytoin change in critically ill patients requiring extracorporeal support. This case study presents a 41-year-old female transferred to the cardiovascular ICU requiring VA ECMO and PLEX for the treatment of systemic lupus erythematosus (SLE)-induced catastrophic antiphospholipid syndrome (CAPS). Free phenytoin concentrations were measured to assess the removal of phenytoin. There was no significant decrease in the free phenytoin concentrations post-PLEX and while on ECMO. Free phenytoin concentrations are not influenced in the setting of PLEX and while on ECMO.
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Affiliation(s)
| | - Caitlin S Brown
- Pharmacy and Emergency Medicine, Mayo Clinic, Rochester, USA
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18
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Michaličková D, Hartinger JM, Hladinová Z, Bednářová V, Szonowská B, Polakovič V, Matthios A, Tesař V, Slanař O, Krekels EHJ. Population pharmacokinetics-pharmacodynamics of fondaparinux in dialysis-dependent chronic kidney disease patients undergoing chronic renal replacement therapy. Eur J Clin Pharmacol 2021; 78:89-98. [PMID: 34414464 DOI: 10.1007/s00228-021-03201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Data on the anti-Xa efficacy of fondaparinux in dialysis-dependent chronic kidney disease (DD-CKD) patients are scarce. This study characterizes the pharmacokinetics (PK) and pharmacodynamics (PD) of fondaparinux in DD-CKD patients undergoing renal replacement therapy (RRT), to assess dosing strategies. METHODS A retrospective, observational study was conducted using data on anti-Xa activity (112 samples) from 12 (3 male and 9 female) DD-CKD patients (median (IQR) age 71 years (63-88), weight 73 kg (59-98.5)). Eleven patients underwent high-flux or low-flux hemodialysis (HD) and one patient underwent peritoneal dialysis. Three patients were also treated with therapeutic plasma exchange (TPE). A non-linear mixed effects analysis was performed using NONMEM 7.3.0. RESULTS The lab-specific slope of the relationship between fondaparinux concentration and anti-Xa levels was 1.18 IU/µg. In a one-compartment model, clearance (CL) and volume of distribution (Vd) were 0.05289 L/h and 5.55 L, respectively. High-flux HD was found to increase the CL of fondaparinux 2.26 times. TPE also considerably increased CL, but the fold-change could not be accurately estimated. Low-flux HD and peritoneal dialysis did not impact PK parameters. CONCLUSIONS Model-based simulations showed that standard dosing (2.5 mg three times weekly before HD) results in a median anti-Xa activity of 0.55 IU/mL and 0.98 IU/mL, pre- and post-low-flux HD, respectively. In patients undergoing high-flux HD, these values are approximately 27% lower. Additional caution is warranted with TPE, as this treatment can reduce anti-Xa activity even further.
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Affiliation(s)
- Danica Michaličková
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic.
| | - Jan Miroslav Hartinger
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic
| | - Zuzana Hladinová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Vladimíra Bednářová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Szonowská
- Internal Department of Strahov, General University Hospital, Prague, Czech Republic
| | - Vladimír Polakovič
- Internal Department of Strahov, General University Hospital, Prague, Czech Republic
| | - Andreas Matthios
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic.,Department of Biophysics and Physical Chemistry, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
| | - Vladimír Tesař
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondřej Slanař
- Institute of Pharmacology, First Faculty of Medicine & General University Hospital, Charles University, Prague, Czech Republic
| | - Elke H J Krekels
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
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19
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Shokouhi S, Barati S, Kazeminia N, Jamali F, Roshan B, Sahraei Z. Evaluating the elimination status of medications used for COVID-19 during hemoperfusion and therapeutic plasma exchange: A review. Int Immunopharmacol 2021; 97:107707. [PMID: 33962224 PMCID: PMC8059942 DOI: 10.1016/j.intimp.2021.107707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022]
Abstract
Since late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, better known as COVID-19) has rapidly spread worldwide. The primary pathophysiology by which COVID-19 leads to severe lung damage is cytokine releasing syndrome (CRS), which can cause death. Therefore, removing cytokines via therapeutic plasma exchange or hemoperfusion could be a therapeutic approach to treat CRS. However, hemoperfusion or therapeutic plasma exchange could alter the effectiveness of concomitant medications. Thus, concomitant medication doses might need to be adjusted to prevent their elimination via therapeutic plasma exchange or hemoperfusion, thus ensuring that these medications remain effective. This narrative review investigates the elimination status of current medications used to manage COVID-19 during hemoperfusion and therapeutic plasma exchange, with a focus on their pharmacokinetic profiles.
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Affiliation(s)
- Shervin Shokouhi
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1333625445, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1333625445, Iran
| | - Saghar Barati
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835113, Iran
| | - Neda Kazeminia
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835113, Iran
| | - Faezeh Jamali
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835113, Iran
| | - Baran Roshan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835113, Iran
| | - Zahra Sahraei
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835113, Iran; Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran 133362544, Iran.
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20
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Liu F, Niko Y, Bouchaala R, Mercier L, Lefebvre O, Andreiuk B, Vandamme T, Goetz JG, Anton N, Klymchenko A. Drug‐Sponge Lipid Nanocarrier for in Situ Cargo Loading and Release Using Dynamic Covalent Chemistry. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/anie.202014259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Fei Liu
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
- INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, CNRS 7199, CAMB Université de Strasbourg 67000 Strasbourg France
| | - Yosuke Niko
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
- Research and Education Faculty, Multidisciplinary Science Cluster Interdisciplinary Science Unit Kochi University 2-5-1, Akebono-cho, Kochi-shi Kochi 780-8520 Japan
| | - Redouane Bouchaala
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
| | - Luc Mercier
- Inserm U1109, Tumor Biomechanics, Fédération de Médecine Translationnelle de Strasbourg (FMTS) University of Strasbourg 67200 Strasbourg France
- Current address: Interdisciplinary Institute for Neuroscience University of Bordeaux, CNRS UMR 5297 33077 Bordeaux France
| | - Olivier Lefebvre
- Inserm U1109, Tumor Biomechanics, Fédération de Médecine Translationnelle de Strasbourg (FMTS) University of Strasbourg 67200 Strasbourg France
| | - Bohdan Andreiuk
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
| | - Thierry Vandamme
- INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, CNRS 7199, CAMB Université de Strasbourg 67000 Strasbourg France
| | - Jacky G. Goetz
- Inserm U1109, Tumor Biomechanics, Fédération de Médecine Translationnelle de Strasbourg (FMTS) University of Strasbourg 67200 Strasbourg France
| | - Nicolas Anton
- INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, CNRS 7199, CAMB Université de Strasbourg 67000 Strasbourg France
| | - Andrey Klymchenko
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
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21
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Liu F, Niko Y, Bouchaala R, Mercier L, Lefebvre O, Andreiuk B, Vandamme T, Goetz JG, Anton N, Klymchenko A. Drug‐Sponge Lipid Nanocarrier for in Situ Cargo Loading and Release Using Dynamic Covalent Chemistry. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/ange.202014259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fei Liu
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
- INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, CNRS 7199, CAMB Université de Strasbourg 67000 Strasbourg France
| | - Yosuke Niko
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
- Research and Education Faculty, Multidisciplinary Science Cluster Interdisciplinary Science Unit Kochi University 2-5-1, Akebono-cho, Kochi-shi Kochi 780-8520 Japan
| | - Redouane Bouchaala
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
| | - Luc Mercier
- Inserm U1109, Tumor Biomechanics, Fédération de Médecine Translationnelle de Strasbourg (FMTS) University of Strasbourg 67200 Strasbourg France
- Current address: Interdisciplinary Institute for Neuroscience University of Bordeaux, CNRS UMR 5297 33077 Bordeaux France
| | - Olivier Lefebvre
- Inserm U1109, Tumor Biomechanics, Fédération de Médecine Translationnelle de Strasbourg (FMTS) University of Strasbourg 67200 Strasbourg France
| | - Bohdan Andreiuk
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
| | - Thierry Vandamme
- INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, CNRS 7199, CAMB Université de Strasbourg 67000 Strasbourg France
| | - Jacky G. Goetz
- Inserm U1109, Tumor Biomechanics, Fédération de Médecine Translationnelle de Strasbourg (FMTS) University of Strasbourg 67200 Strasbourg France
| | - Nicolas Anton
- INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, CNRS 7199, CAMB Université de Strasbourg 67000 Strasbourg France
| | - Andrey Klymchenko
- Université de Strasbourg Laboratoire de Bioimagerie et Pathologies UMR 7021 CNRS 74 route du Rhin 67401 Illkirch France
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22
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Sanchez AP, Balogun RA. Therapeutic Plasma Exchange in the Critically Ill Patient: Technology and Indications. Adv Chronic Kidney Dis 2021; 28:59-73. [PMID: 34389138 DOI: 10.1053/j.ackd.2021.03.005] [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: 09/03/2020] [Revised: 01/20/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022]
Abstract
Therapeutic plasma exchange (TPE) is frequently the most common Apheresis Medicine technique used for extracorporeal therapy of a wide variety of renal, neurological, hematological, and other clinical indications. Many of these clinical indications require intensive care during critical illness. Conventional TPE uses one of two main technical methods to achieve the goal of removing known disease mediators from the plasma: using centrifugal forces to separate and remove components of blood, or a membrane filtration method that separates plasma from the cellular components of blood. The following review discusses the basic principles of TPE, the technological aspects, and relevant clinical scenarios encountered in the intensive care unit, including relevant guidelines and recommendations from the American Society for Apheresis.
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23
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Grazioli A, Athale J, Tanaka K, Madathil R, Rabin J, Kaczorowski D, Mazzeffi M. Perioperative Applications of Therapeutic Plasma Exchange in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 34:3429-3443. [DOI: 10.1053/j.jvca.2020.01.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
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24
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Goto Y, Nakajima T, Suzuki T, Yamazaki S, Suzuki T, Yoshino I, Ishii I. Evaluation of tacrolimus and mycophenolic acid removal by simultaneous continuous hemodiafiltration and plasma exchange in a lung transplant patient. J Clin Pharm Ther 2020; 46:515-518. [PMID: 33037823 DOI: 10.1111/jcpt.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The removal rates of tacrolimus (TAC) and mycophenolic acid (MPA) by simultaneous plasma exchange (PE) and continuous hemodiafiltration (CHDF) are not clear. CASE SUMMARY We evaluated the removal rates of TAC and MPA by PE and CHDF started simultaneously 5 hours after administration in a lung transplant patient. TAC was not removed. MPA was transferred into the PE effluent, but the total amount in the effluent was only 1% of the dosage. WHAT IS NEW AND CONCLUSION TAC and MPA were less likely to be removed by PE and CHDF initiated 5 hours after administration.
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Affiliation(s)
- Yuri Goto
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tatsuya Suzuki
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Shingo Yamazaki
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Takaaki Suzuki
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Itsuko Ishii
- Division of Pharmacy, Chiba University Hospital, Chiba, Japan
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25
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Safi M, Ahmed H, Al-Azab M, Xia YL, Shan X, Al-radhi M, Al-danakh A, Shopit A, Liu J. PD-1/PDL-1 Inhibitors and Cardiotoxicity; Molecular, Etiological and Management Outlines. J Adv Res 2020; 29:45-54. [PMID: 33842004 PMCID: PMC8020146 DOI: 10.1016/j.jare.2020.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022] Open
Abstract
Background The US Food and Drug Administration (FDA) has approved several immunotherapeutic drugs for cancer since 2010, and many more are still being evaluated in other clinical studies. These inhibitors significantly increase response rates and result in the treatment of patients with advanced cancer. However, cancer immunotherapy leads to essential cardiac toxicity properties that have become distinct from other cancer patients' care and are mostly related to their etiology. Aim of review As potential implications, the occurrence of cardiovascular adverse events is particularly challenging and needs a comprehensive understanding of overall cancer-related etiology, clinical outcomes with different variable severity, and management. Key scientific concepts of review In terms of improving the overall survival of patients with cancer, clinicians should be careful in selecting either programmed cell death-1 (PD-1) or its programmed cell death ligand (PDL-1) inhibitors by evaluating their risk and clinical benefit for early intervention and decrease the level of morbidity and mortality of their patients. This review focuses on the effectiveness of PD-1/PL-1 antibodies and associated cardiotoxicity adverse events, including etiological mechanisms, diagnosis, and treatment.
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Affiliation(s)
- Mohammed Safi
- Department of Oncology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian 116021, China
| | - Hyat Ahmed
- Department of Stomatology, Oral Pathology, Dalian Medical University, Zhongshan Road No. 222, Dalian 116021, China
| | - Mahmoud Al-Azab
- Department of Immunology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Yun-long Xia
- Head of Department of Cardiology, Vice president of the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian 116021, Liaoning, China
| | - Xiu Shan
- First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian 116021, China
| | - Mohammed Al-radhi
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian 116021, China
| | - Abdullah Al-danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Dalian 116021, China
| | - Abdullah Shopit
- Department of Pharmacology, Dalian Medical University, Zhongshan Road No. 222, Dalian 116021, China
| | - Jiwei Liu
- Head of Department of Oncology First Affiliated Hospital of Dalian Medical University, Zhongshan Road Dalian, Dalian Liaoning Province 116044, China
- Corresponding author.
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Wang X, Du W, Zhang X, Li P. The Influence of Different Disease States on Rituximab Pharmacokinetics. Curr Drug Metab 2020; 21:938-946. [PMID: 32682367 DOI: 10.2174/1389200221666200719004035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The anti-CD20 antibody rituximab, which promotes the selective depletion of CD20 positive B cells, was the first targeted therapy that was approved for the treatment of B-cell malignancies, and it is now widely prescribed in both malignant and non-malignant, immune-related diseases. However, the cause of its various clinical responses in certain diseases, have not been clearly elucidated. The variabilities in inter-individual pharmacokinetic and the emerging evidence of the relationships between pharmacokinetic and pharmacodynamic may provide a better understanding of this drug. METHODS We searched and summarized the latest published articles on rituximab pharmacokinetic profiles and the pharmacokinetic/pharmacodynamic models in different patient populations, including B-cell malignancies, rheumatoid arthritis, ANCA-associated vasculitis, and glomerular kidney diseases. RESULTS Most pharmacokinetic data are drawn from clinical studies in oncology clinical practice. Body weight, gender, and antigen-related factors are proven to be the key factors affecting rituximab pharmacokinetics. In addition, the positive exposure-response relations were reported, which provide encouraging evidence for individualized therapies. While in immune disorders, especially in the off-labeled indications, pharmacokinetic studies are quite limited. Compared with that in B-cell malignancies, the differences in the pharmacokinetic parameters may be attributed to the different pathogeneses of diseases, mechanisms of action and dosing strategies. However, the correlation between drug exposure and clinical outcomes remains unclear. CONCLUSION Here, we provide an overview of the complexities associated with rituximab pharmacokinetics and pharmacodynamics in different diseases. Although many influencing factors need to be verified in future studies, a better understanding of the relationships between pharmacokinetic and pharmacodynamic may assist in optimizing rituximab clinical practice.
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Affiliation(s)
- Xiaoxing Wang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wenwen Du
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xianglin Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China
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27
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Abstract
Therapeutic plasma exchange (TPE) is an extracorporeal process in which a large volume of whole blood is taken from the patient's vein. Plasma is then separated from the other cellular components of the blood and discarded while the remaining blood components may then be returned to the patient. Replacement fluids such as albumin or fresh-frozen plasma may or may not be used. TPE has been used clinically for the removal of pathologic targets in the plasma in a variety of conditions, such as pathogenic antibodies in autoimmune disorders. TPE is becoming more common in the neurointensive care space as autoimmunity has been shown to play an etiological role in many acute neurological disorders. It is important to note that not only does TPE removes pathologic elements from the plasma, but may also remove drugs, which may be an intended or unintended consequence. The objective of the current review is to provide an up-to-date summary of the available evidence pertaining to drug removal via TPE and provide relevant clinical suggestions where applicable. This review also aims to provide an easy-to-follow clinical tool in order to determine the possibility of a drug removal via TPE given the procedure-specific and pharmacokinetic drug properties.
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Fujii M, Karumai T, Yamamoto R, Kobayashi E, Ogawa K, Tounai M, Lipman J, Hayashi Y. Pharmacokinetic and pharmacodynamic considerations in antimicrobial therapy for sepsis. Expert Opin Drug Metab Toxicol 2020; 16:415-430. [DOI: 10.1080/17425255.2020.1750597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Motoki Fujii
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Infectious Disease, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshiyuki Karumai
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ryohei Yamamoto
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Eri Kobayashi
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kenta Ogawa
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Mayuko Tounai
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
- Scientific Consultant, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
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Mazepa MA, Park YA, Raval JS. Taking Empiricism out of Immune Thrombotic Thrombocytopenic Purpura: Current and Future Treatment Strategies. Transfus Med Rev 2019; 33:248-255. [DOI: 10.1016/j.tmrv.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 06/10/2019] [Accepted: 06/29/2019] [Indexed: 01/05/2023]
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Pham HP, Staley EM, Schwartz J. Therapeutic plasma exchange – A brief review of indications, urgency, schedule, and technical aspects. Transfus Apher Sci 2019; 58:237-246. [DOI: 10.1016/j.transci.2019.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Monroig-Bosque PDC, Balk J, Segura F, Salazar E, Leveque CM, Ipe TS. The utility of therapeutic plasma exchange for amphotericin B overdose. Transfus Apher Sci 2018; 57:756-758. [DOI: 10.1016/j.transci.2018.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/27/2018] [Accepted: 09/12/2018] [Indexed: 12/31/2022]
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