Outpatient talc pleurodesis supported for malignant pleural effusion
medwireNews: The achievement of pleurodesis is twice as likely with the incorporation of talc administration into the outpatient indwelling pleural catheter (IPC) protocol in patients with malignant pleural effusion, suggests the UK-based IPC-Plus trial.
Of the 139 participants without extensive lung entrapment who had an IPC inserted for the treatment of symptomatic malignant pleural effusion, 43% of the 69 patients who were randomly assigned to receive 4 g of a talc slurry via the IPC achieved pleurodesis at day 35, defined as a drainage volume below 50 mL on three consecutive occasions, with less than 25% opacification on radiographs.
This was significantly higher than the 23% rate observed for the 70 patients given a placebo through the IPC, and equated to a hazard ratio of 2.20.
I suspect this study may lead to increased fervor for the use of talc in this population.
The difference between groups remained significant at day 70, with corresponding rates of 51% and 27%, lead author Rahul Bhatnagar (University of Bristol, UK) and colleagues report in The New England Journal of Medicine.
Talc-treated patients also reported better quality of life and symptom scores throughout the study, and there was no significant increase in the incidence of adverse events in the talc versus placebo group.
The researchers therefore conclude: “[T]he administration of talc through an indwelling pleural catheter in an outpatient setting was not detrimental, either to the patient or the device.”
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