Evidence map›Paper›PMID 31641402›Full record

ArticleThe World Allergy Organization journal2019

Fresh frozen plasma for on-demand hereditary angioedema treatment in South Africa and Iran.

Nicole Wentzel, Angelica Panieri, Maryam Ayazi, Sipho Duncan Ntshalintshali, Zahra Pourpak, Di Hawarden, Paul Potter, Michael E Levin, Mohammad Reza Fazlollahi, Jonathan Peter

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The World Allergy Organization journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 2 pooled it
2.9field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.

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  15. Bradykinin-induced angioedema in the emergency department.International journal of emergency medicine · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

Nicole WentzelFaculty of Health Sciences, University of Cape Town, South Africa.
Angelica PanieriFaculty of Health Sciences, University of Cape Town, South Africa.
Maryam AyaziImmunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Sipho Duncan NtshalintshaliDepartment of Internal Medicine, Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa.
Zahra PourpakImmunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Di HawardenAllergy and Clinical Immunology, Department of Medicine, University of Cape Town, South Africa & Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
Paul PotterAllergy and Clinical Immunology, Department of Medicine, University of Cape Town, South Africa & Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
Michael E LevinDivision of Allergy, Department of Paediatrics, University of Cape Town, South Africa.
Mohammad Reza FazlollahiImmunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Jonathan PeterAllergy and Clinical Immunology, Department of Medicine, University of Cape Town, South Africa & Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
University of Cape Town · ZATehran University of Medical Sciences · IRQueen Nandi Regional Hospital · ZA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundInternational guideline-recommended on-demand treatments for hereditary angioedema (HAE) include: C1-esterase inhibitor (plasma-derived or recombinant), or bradykinin-receptor antagonists. In most low- and middle-income countries (LMIC) these products are not registered or are unaffordable. Solvent-detergent, fresh or freeze-dried plasma therapy is thus the only available on-demand treatment in these settings; but published data on efficacy and safety are limited. This study evaluated the efficacy and safety of on-demand plasma treatment of acute HAE in two LMICs.

methodsA retrospective folder or patient registry review of acute swelling episodes necessitating emergency room attendance amongst known HAE patients was conducted at treatment centers in South Africa and Iran. Data collected included the site of angioedema, timing and amount of fresh frozen plasma (FFP) administered, time-to-resolution, hospital length of stay and adverse events.

resultsThere were 176 acute swelling episodes amongst 43 HAE patients; 98 were treated with FFP. The face, upper airway, and abdomen were involved in 15.3% (15/98), 53.1% (52/98) and 29.6% (29/98) of episodes treated with FFP respectively. Median (interquartile range ([IQR]) of FFP administered was 400 (280-560) mLs. In all episodes except two, FFP led to resolution, with median (IQR) hours to resolution 4 (2-12). Five transfusion reactions occurred, with one case of anaphylaxis and no deaths; giving an adverse reaction rate of 5%. Differences between South Africa and Iran included: (1) proportion of HAE type II(2) median (IQR) hours to FFP administration and hospitalization, (3) number of intubations after FFP infusion. Healthcare cost for FFP treatment was USD369- 791 in South Africa and USD275-550 in Iran, largely influenced by hospital length of stay.

conclusionsPlasma (fresh-frozen) remains the only available effective on-demand treatment for acute HAE in many countries. FFP is effective and safe, but time-to-resolution is slower and adverse events are more frequent than published data on targeted therapies. Overall healthcare cost of FFP approaches that of targeted therapies - now available through global access programs - when hospitalization is prolonged.

Indexed as

C1–INH, C1-esterase inhibitorCTCAE, common terminology criteria for adverse eventsFAST, for angioedema subcutaneous treatmentFFP, fresh frozen plasmaFresh frozen plasmaHAE, hereditary angioedemaHereditary angioedemaIQR, interquartile rangeLMIC, low- and middle-income countrySAE, serious adverse eventSA, South Africa(n)TEAE, treatment-emergent adverse eventTreatmentUSA, United States of AmericaUSD, United States dollarWAO, World Allergy Organisation

Identifiers

PMID31641402
PMCPMC6796769
OpenAlexW2979501838

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.