PP16 AN ALTERNATIVE FOR DORNASE ALFA IN FUTURE?

Vijayan Munusamy, Liam CK,Wong CK, Pang YK, Tan JL, Loh TC,  Earnest PME LC, Husna Ibrahim, Ian Soo, Mohd Faisal
Faculty of Medicine ,University Malaya Medical Center, Kuala Lumpur, Malaysia
Faculty of Medicine,University Kebangsaan Malaysia, Kuala Lumpur, Malaysia

Background: 

Intrapleural fibrinolytic therapy (IPFT) represents an effective treatment option for complex pleural effusion, but its widespread use is limited by cost considerations and the availability of pulmozyme. Tacholiquin has emerged as a practical alternative due to its similar efficacy and lower cost, offering a 40% reduction in treatment expenses. Here, we present a series of six patients who benefited from this alternative approach.

Methods: 

From January 2024 to June 2024, six patients diagnosed with complex pleural effusion were treated at Universiti Malaya Medical Center. This study analyzed patient demographics, chest imaging findings, cost reduction strategies, inflammatory parameters, and treatment outcomes.

Results: 

All patients were between 48 and 88 years old and underwent pleural pigtail insertion, confirmed by thoracic ultrasound to show exudative and complex pleural effusion. They exhibited an LDH ratio greater than 1.7, with four patients having LDH levels exceeding 1000 U/L. Two patients had positive pleural fluid cultures, and one patient's pleural fluid showed purulence. Despite late referral, all patients received standard intrapleural tissue plasminogen activator (t-PA) and alternative options tacholiquin therapy for three days. Inflammatory markers decreased by 30% in the first week, 70% by the fourth week, and normalised after ten weeks. Chest radiograph improvements were noted at 40% by week 1 and 90% by weeks 4-8 post-intervention. The total cost for tacholiquin was RM 200 compared to RM 1600 for Dornase Alfa.

Conclusion: 

Intrapleural fibrinolytic therapy with tacholiquin demonstrated comparable efficacy to conventional alternatives in terms of radiological outcomes, inflammatory parameters, and significant cost reduction.