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RCT of Urokinase in Malignant Pleural Effusions

By Jadwiga A. Wedzicha, MD, editor, American Journal of Respiratory and Critical Care Medicine
Follow Dr. Wedzicha on Twitter @ATSBlueEditor

Randomized Controlled Trial of Urokinase versus Placebo for Non-draining Malignant Pleural Effusion

In the Feb. 15 American Journal of Respiratory and Critical Care Medicine, Eleanor K. Mishra, MD, and co-investigators report on the first randomized, placebo-controlled trial to assess the effect of adjunctive intrapleural urokinase on improving pleurodosis is patients with malignant pleural effusion. The researchers found that there was “no difference in the key clinical outcomes of dyspnea or time to pleurodesis failure over one year.”

There was a small, but statistically significant, decrease in mortality in the urokinase group, which may be explained by an excess of patients with lung cancer in the placebo group, and those in the urokinase group had shorter hospital stays.  Both findings, the authors say, should be investigated in future studies. Meanwhile, they conclude, “alternative palliative measures should be used to relieve breathlessness in this patient group.”

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