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Snakebite-associated thrombotic microangiopathy: a spotlight on pharmaceutical interventions
Tina Noutsos1, Geoffrey K Isbister2
1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Expert Review of Clinical Pharmacology
|June 1, 2023
Summary
Limited evidence supports current treatments for snakebite-associated thrombotic microangiopathy (TMA). More research, including randomized controlled trials (RCTs), is crucial to establish effective therapies for this neglected public health issue.
Area of Science:
- Nephrology
- Toxicology
- Hematology
Background:
- Snakebite is a significant global health problem, particularly in resource-limited regions.
- Snakebite-associated thrombotic microangiopathy (TMA) can lead to acute kidney injury and chronic kidney disease.
Purpose of the Study:
- To review current evidence on therapeutic interventions for snakebite-associated TMA.
- To identify gaps in research and the need for future clinical trials.
Main Methods:
- Systematic PubMed search for cohort studies and randomized controlled trials (RCTs) on snakebite-associated TMA from 1970 to October 2022.
- Synthesis of evidence on antivenom and therapeutic plasma exchange (TPE).
Main Results:
- No interventional RCTs exist for snakebite-associated TMA.
- Cohort studies show no consistent evidence supporting TPE for improved survival or reduced hospital stay.
- Antivenom is standard for envenoming but lacks specific evidence for TMA benefit.
Conclusions:
- Current treatments like TPE and antivenom lack robust evidence for efficacy in snakebite-associated TMA.
- There is an urgent need for high-quality RCTs to guide treatment strategies.
- Emerging therapies for snakebite require testing in TMA.
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