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Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial.

Publication ,  Journal Article
Shrager, JB; Bhatnagar, R; Kearney, CT; Retzlaff, NP; Cohen, E; Stanton, AE; Keyes, C; Wahidi, MM; Gillespie, C; Rahman, N; Kerry, AL; Chen, A ...
Published in: Ann Am Thorac Soc
October 2022

Rationale: Tunneled, indwelling pleural catheters (IPCs) have been demonstrated to be an effective method of managing malignant pleural effusions. However, they allow pleurodesis and can therefore be removed in only a subset of patients. A novel, silver nitrate-coated IPC was developed with the intention of creating a rapid, effective chemical pleurodesis to allow more frequent and earlier catheter removal. This study represents the pivotal clinical trial evaluating that catheter versus the standard IPC. Objectives: To compare the efficacy of a novel silver nitrate-eluting indwelling pleural catheter (SNCIPC) with that of a standard, uncoated catheter. Methods: The SWIFT [A Pivotal Multi-Center, Randomized, Controlled, Single-Blinded Study Comparing the Silver Nitrate-Coated Indwelling Pleural Catheter (SNCIPC) to the Uncoated PleurX® Pleural Catheter for the Management of Symptomatic, Recurrent, Malignant Pleural Effusions] trial was a multicenter, parallel-group, randomized, controlled, patient-blind trial. Central randomization occurred according to a computer-generated schedule, stratified by site. Recruitment was from 17 secondary or tertiary care hospitals in the United States and 3 in the United Kingdom and included adult patients with malignant pleural effusion needing drainage, without evidence of lung entrapment or significant loculation. The intervention group underwent insertion of an SNCIPC with maximal fluid drainage, followed by a tapering drainage schedule. The control group received a standard, uncoated catheter. Follow-up was conducted until 90 days. The primary outcome measure was pleurodesis efficacy, measured by fluid drainage, at 30 days. Results: A total of 119 patients were randomized. Five withdrew before receiving treatment, leaving 114 (77 SNCIPC, 37 standard IPC) for analysis. The mean age was 66 years (standard deviation, 11). More patients in the SNCIPC group were inpatients (39% vs. 14%; P = 0.009). For the primary outcome, pleurodesis rates were 12 (32%) of 37 in the control group and 17 (22%) of 77 in the SNCIPC group (rate difference, -0.10; 95% confidence interval, -0.30 to 0.09). Median time to pleurodesis was 11 days (interquartile range, 9 to 23) in the control group and 4 days (interquartile range, 2 to 15) in the SNCIPC group. No significant difference in treatment-related adverse event rates was noted between groups. Conclusions: The SNCIPC did not improve pleurodesis efficacy compared with a standard IPC. This study does not support the wider use of the SNCIPC device. Clinical trial registered with www.clinicaltrials.gov (NCT02649894).

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

October 2022

Volume

19

Issue

10

Start / End Page

1722 / 1729

Location

United States

Related Subject Headings

  • Talc
  • Silver Nitrate
  • Pleurodesis
  • Pleural Effusion, Malignant
  • Humans
  • Drainage
  • Catheters, Indwelling
  • Aged
  • Adult
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shrager, J. B., Bhatnagar, R., Kearney, C. T., Retzlaff, N. P., Cohen, E., Stanton, A. E., … Maskell, N. A. (2022). Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial. Ann Am Thorac Soc, 19(10), 1722–1729. https://doi.org/10.1513/AnnalsATS.202111-1301OC
Shrager, Joseph B., Rahul Bhatnagar, Christine T. Kearney, Nathan P. Retzlaff, Evan Cohen, Andrew E. Stanton, Colleen Keyes, et al. “Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial.Ann Am Thorac Soc 19, no. 10 (October 2022): 1722–29. https://doi.org/10.1513/AnnalsATS.202111-1301OC.
Shrager JB, Bhatnagar R, Kearney CT, Retzlaff NP, Cohen E, Stanton AE, et al. Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial. Ann Am Thorac Soc. 2022 Oct;19(10):1722–9.
Shrager, Joseph B., et al. “Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial.Ann Am Thorac Soc, vol. 19, no. 10, Oct. 2022, pp. 1722–29. Pubmed, doi:10.1513/AnnalsATS.202111-1301OC.
Shrager JB, Bhatnagar R, Kearney CT, Retzlaff NP, Cohen E, Stanton AE, Keyes C, Wahidi MM, Gillespie C, Rahman N, Kerry AL, Feller-Kopman D, Nader D, Akulian J, Chen A, Berry M, Majid A, Reddy C, Tremblay A, Maskell NA. Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial. Ann Am Thorac Soc. 2022 Oct;19(10):1722–1729.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

October 2022

Volume

19

Issue

10

Start / End Page

1722 / 1729

Location

United States

Related Subject Headings

  • Talc
  • Silver Nitrate
  • Pleurodesis
  • Pleural Effusion, Malignant
  • Humans
  • Drainage
  • Catheters, Indwelling
  • Aged
  • Adult
  • 3202 Clinical sciences