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Vipera ammodytes bites treated with antivenom ViperaTAb: a case series with pharmacokinetic evaluation.
Clin Toxicol (Phila). 2017 Apr; 55(4):241-248.CT

Abstract

CONTEXT

In clinical practice it is difficult to differentiate between V. berus and V. ammodytes venomous bites. In the past this was not a concern, but due to the current shortage in Viperfav™ and European viper venom antiserum availability, V. a. ammodytes venomous bites have recently been treated with ViperaTAb®, which is a pharmaceutical formulation containing a monospecific ovine Fab fragments against the venom of V. berus.

OBJECTIVE

To evaluate ViperaTAb® in V. a. ammodytes envenomations.

MATERIALS AND METHODS

This is a prospective case series of three consecutive patients envenomed by V. a. ammodytes snakebite treated with ViperaTAb®. V. ammodytes venom, neurotoxic ammodytoxins, and Fab fragment levels were determined in serum samples and a pharmacokinetic analysis of the antivenom Fab fragments was carried out.

RESULTS

Three patients bitten by V. a. ammodytes with extensive local swelling, neurological symptoms and recurrent thrombocytopenia were treated with ViperaTAb®. V. ammodytes venom was detected in serum of all three patients. Ammodytoxins were detected in the serum of only the most severely envenomed patient who developed neurological symptoms. In the presented moderate cases, a dose of 8 mL of ViperaTAb® reduced swelling and improved systemic effects, such as thrombocytopenia. However, this dose of ViperaTAb® was not effective in the most severely envenomed patient with the highest serum values of V. ammodytes venom. In this case ViperaTAb® did not stop local swelling and it had no effect on neurological signs. ViperaTAb®'s systemic clearance, distribution and elimination half-lives were 4.3-13.4 mL/h/kg, 1.2-3.2 h and 14.1-55.4 h, respectively.

CONCLUSIONS

In patients envenomed by V. a. ammodytes venom, ViperaTAb® reduces moderate swelling and temporarily improves systemic effects, except neurological symptoms. ViperaTAb® application induces a decrement of V. ammodytes venom level in the blood, but did not affect serum concentration of neurotoxic ammodytoxins in the one patient with measurable concentrations.

Authors+Show Affiliations

a Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana , Ljubljana , Slovenia. b Faculty of Medicine , Institute of Pathophysiology, University of Ljubljana , Ljubljana , Slovenia.c Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb , Zagreb , Croatia.a Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana , Ljubljana , Slovenia.c Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb , Zagreb , Croatia.d Department of Molecular and Biomedical Sciences , Jožef Stefan Institute , Ljubljana , Slovenia. e Faculty of Chemistry and Chemical Technology , University of Ljubljana , Ljubljana , Slovenia.c Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb , Zagreb , Croatia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28092984

Citation

Brvar, Miran, et al. "Vipera Ammodytes Bites Treated With Antivenom ViperaTAb: a Case Series With Pharmacokinetic Evaluation." Clinical Toxicology (Philadelphia, Pa.), vol. 55, no. 4, 2017, pp. 241-248.
Brvar M, Kurtović T, Grenc D, et al. Vipera ammodytes bites treated with antivenom ViperaTAb: a case series with pharmacokinetic evaluation. Clin Toxicol (Phila). 2017;55(4):241-248.
Brvar, M., Kurtović, T., Grenc, D., Lang Balija, M., Križaj, I., & Halassy, B. (2017). Vipera ammodytes bites treated with antivenom ViperaTAb: a case series with pharmacokinetic evaluation. Clinical Toxicology (Philadelphia, Pa.), 55(4), 241-248. https://doi.org/10.1080/15563650.2016.1277235
Brvar M, et al. Vipera Ammodytes Bites Treated With Antivenom ViperaTAb: a Case Series With Pharmacokinetic Evaluation. Clin Toxicol (Phila). 2017;55(4):241-248. PubMed PMID: 28092984.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vipera ammodytes bites treated with antivenom ViperaTAb: a case series with pharmacokinetic evaluation. AU - Brvar,Miran, AU - Kurtović,Tihana, AU - Grenc,Damjan, AU - Lang Balija,Maja, AU - Križaj,Igor, AU - Halassy,Beata, Y1 - 2017/01/17/ PY - 2017/1/18/pubmed PY - 2017/3/3/medline PY - 2017/1/18/entrez KW - Fab fragments KW - V. a. ammodytes KW - ViperaTAb KW - nose-horned viper KW - pharmacokinetics SP - 241 EP - 248 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 55 IS - 4 N2 - CONTEXT: In clinical practice it is difficult to differentiate between V. berus and V. ammodytes venomous bites. In the past this was not a concern, but due to the current shortage in Viperfav™ and European viper venom antiserum availability, V. a. ammodytes venomous bites have recently been treated with ViperaTAb®, which is a pharmaceutical formulation containing a monospecific ovine Fab fragments against the venom of V. berus. OBJECTIVE: To evaluate ViperaTAb® in V. a. ammodytes envenomations. MATERIALS AND METHODS: This is a prospective case series of three consecutive patients envenomed by V. a. ammodytes snakebite treated with ViperaTAb®. V. ammodytes venom, neurotoxic ammodytoxins, and Fab fragment levels were determined in serum samples and a pharmacokinetic analysis of the antivenom Fab fragments was carried out. RESULTS: Three patients bitten by V. a. ammodytes with extensive local swelling, neurological symptoms and recurrent thrombocytopenia were treated with ViperaTAb®. V. ammodytes venom was detected in serum of all three patients. Ammodytoxins were detected in the serum of only the most severely envenomed patient who developed neurological symptoms. In the presented moderate cases, a dose of 8 mL of ViperaTAb® reduced swelling and improved systemic effects, such as thrombocytopenia. However, this dose of ViperaTAb® was not effective in the most severely envenomed patient with the highest serum values of V. ammodytes venom. In this case ViperaTAb® did not stop local swelling and it had no effect on neurological signs. ViperaTAb®'s systemic clearance, distribution and elimination half-lives were 4.3-13.4 mL/h/kg, 1.2-3.2 h and 14.1-55.4 h, respectively. CONCLUSIONS: In patients envenomed by V. a. ammodytes venom, ViperaTAb® reduces moderate swelling and temporarily improves systemic effects, except neurological symptoms. ViperaTAb® application induces a decrement of V. ammodytes venom level in the blood, but did not affect serum concentration of neurotoxic ammodytoxins in the one patient with measurable concentrations. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/28092984/Vipera_ammodytes_bites_treated_with_antivenom_ViperaTAb:_a_case_series_with_pharmacokinetic_evaluation_ L2 - https://www.tandfonline.com/doi/full/10.1080/15563650.2016.1277235 DB - PRIME DP - Unbound Medicine ER -