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Tytuł:
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Comparison of F(ab') 2 and Fab antivenoms in rattlesnake envenomation: First year's post-marketing experience with F(ab') 2 in New Mexico.
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Autorzy:
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Mascarenas DN; University of New Mexico Health Sciences Center, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, USA. Electronic address: .
Fullerton L; University of New Mexico Health Sciences Center, Department of Emergency Medicine, USA.
Smolinske SC; New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Warrick BJ; University of New Mexico Health Sciences Center, Department of Emergency Medicine, USA; New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Seifert SA; University of New Mexico Health Sciences Center, Department of Emergency Medicine, USA; New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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Źródło:
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Toxicon : official journal of the International Society on Toxinology [Toxicon] 2020 Oct 30; Vol. 186, pp. 42-45. Date of Electronic Publication: 2020 Aug 05.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Oxford ; New York : Pergamon Press, c1962-
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MeSH Terms:
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Antivenins*
Immunoglobulin Fab Fragments*
Snake Bites*
Adolescent ; Animals ; Crotalid Venoms ; Crotalus ; Female ; Humans ; Male ; Marketing ; Mexico ; Middle Aged ; New Mexico
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Contributed Indexing:
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Keywords: Crotalinae; Hematologic; Hypersensitivity; Serum sickness; Snakebite
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Substance Nomenclature:
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0 (Antivenins)
0 (Crotalid Venoms)
0 (Crotalidae Polyvalent immune Fab)
0 (Immunoglobulin Fab Fragments)
92VV7G83ED (anavip)
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Entry Date(s):
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Date Created: 20200809 Date Completed: 20201002 Latest Revision: 20201002
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Update Code:
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20240105
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DOI:
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10.1016/j.toxicon.2020.08.002
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PMID:
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32763251
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Two antivenoms are available for rattlesnake envenomations in the U.S., Fab (CroFab®, BTG, UK), and F(ab') 2 (Anavip®, Bioclon, Mexico) antivenom (AV) with F(ab') 2 AV released in October 2018. The F(ab') 2 AV Phase 3 comparative clinical trial demonstrated similar efficacy in treating venom-caused hematologic toxicity, similar rates of Types I and III hypersensitivity reactions, and a lower rate of recurrent hematological effects than FabAV. We hypothesized that a post-marketing, comparative study of effectiveness and rates of hypersensitivity reactions in treating rattlesnake envenomations in New Mexico would demonstrate similar outcomes. Patients eligible for the study presented to a New Mexico healthcare facility between May and October 2019 and were known/suspected to have a rattlesnake bite. Exclusion criteria for antivenom comparison were those with a dry bite, lost to follow-up, or late presentation. All cases were included for patient/bite demographics, initial local control, hematological control, number of maintenance/control doses, development of persistent, recurrent or late-, new-onset hematologic effects, and hypersensitivity reactions. We used Fisher's exact tests for analysis and 0.05 cutoff to determine significance. There were 54 rattlesnake-bitten patients in New Mexico with 17 excluded for comparison of antivenom because of dry bites, loss to follow-up, and one case of late presentation. Thirty-seven patients remained for comparative analysis between F(ab') 2 AV (n = 11) and FabAV (n = 26). There were no significant demographic differences between F(ab') 2 and Fab-treated patients. No patient had a Type I hypersensitivity reaction. No rescue doses were given. The rate of recurrent, persistent or late-, new-onset of hematologic effects was 0% with F(ab') 2 AV and 29% with FabAV. No patient was readmitted. No patient had bleeding complications. Type III hypersensitivity reactions were similar between F(ab') 2 AV (36%) and FabAV (25%). The results of our study are consistent with the Phase 3 clinical comparative trial and indicate no significant differences in safety or effectiveness between FabAV and F(ab') 2 AV. F(ab') 2 AV offers the advantages of not requiring maintenance doses and may have a lower rate of late hematologic effects in treating rattlesnake envenomations.
(Copyright © 2020 Elsevier Ltd. All rights reserved.)