LETTER
Controversy over Sclerotherapy for Malignant Pleural Effusions
Daniel J. Wallace, MD
15 July 1994 | Volume 121 Issue 2 | Pages 150-151
TO THE EDITOR:
The comprehensive review by Walker-Renard and colleagues [1] of chemical pleurodesis for malignant pleural effusions claimed to have selected all articles since 1966 involving 1168 patients treated with 13 different agents.
Inexplicably, one of the most important agents, quinacrine, was omitted. Far more commonly used than most of the chemicals discussed, quinacrine is an extremely effective agent. For example, within the last year it was shown to be superior to bleomycin in a randomized study [2]. Two other relevant studies are cited here that allow the reader to access the 20 to 30 articles on the subject, detailing experiences with more than 100 patients [3, 4].
Quinacrine (also known as Atabrine [Sanofi Winthrop, New York, New York] or mepacrine) is an antimalarial drug with potent immunomodulating effects [5]. Although no longer available through its long-time manufacturer, quinacrine can be obtained from more than 2000 compounding pharmacists in the United States.
1. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med. 1994; 120:56-64.
2. Koldsland S, Svennevig JL, Lehne G, Johnson E. Chemical pleurodesis in malignant pleural effusions: a randomised prospective study of mepacrine versus bleomycin. Thorax. 1993; 48:790-3.
3. Janzig HM, Derom A, Derom E. Intrapleural quinacrine instillation for recurrent pneumothorax or persistent air leak. Ann Thorac Surg. 1993; 55:369-71.
4. Argenius V, Chmielewska J, Widstrom O, Blomback M. Pleural fibrinolytic activity is decreased in inflammation as demonstrated in quinacrine pleurodesis treatment of malignant pleural effusion. Am Rev Respir Dis. 1989; 140:1381-5.
5. Wallace DJ. The use of quinacrine (Atabrine) in rheumatic diseases: a reexamination. Semin Arthritis Rheum. 1989; 18:282-97.
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