Anti-IL17A, Ixekizumab, for treatment-resistant chronic venous leg ulcers: A phase II randomized, double-blind, placebo-controlled pilot trial

Chronic venous leg ulcers cause significant morbidity in patients and the majority reoccur after resolution. The current standard of care, double layer compression, is not effective in all patients. Interleukin 17A (IL17) antagonist therapy has been shown to promote healing in murine models of chronic wounds. This has not previously been explored in humans. Therefore, we aim to undertake a phase II randomized, double-blinded, placebo-controlled pilot trial to assess whether Ixekizumab, an anti-IL17A therapy, is effective at reducing chronic venous ulcer size. In addition, to determine the feasibility and safety of undertaking a randomized control trial. Patients with a venous leg ulcer not responsive to 4 weeks of compression therapy were recruited. Participant were randomized to receive either Ixekizumab (80mg) or placebo injected subcutaneously every fortnight for 12 weeks while continuing standard of care. From 30 eligible, 4 patients consented, were enrolled and randomized. Initially, COVID-19 risk, medical history and distance from recruiting site were the main causes of exclusion or refusal to participate. All participants completed the 12-week treatment period. At completion, two participants in the Ixekizumab group reduced by >40% and one completely resolved their ulcer. Ulcers in the Ixekizumab group reduced by an average size of 955mm2 to 529mm2at baseline to final review respectively (p-value 0.12). The placebo group reduced in size by <5%.There were no adverse events related to the intervention. This pilot clinical trial investigated a novel treatment for chronic venous ulcers and showed IL17 inhibition does not impede and may improve chronic wound healing. It also showed a lack of major safety issues in using anti-IL17A therapy in this population. Moreover, the findings reinforce the feasibility of a larger trial to more accurately evaluate anti-inflammatory strategies in chronic wounds.Copyright © 2023

May-Husni Procedure. A Case Report With 24-year Follow-up

Background: Treatment of deep venous system obstruction of the lower limb is a challenge. There are few cases described in the literature even less with long-term follow-up which justifies this presentation. The objective is to report the case of a patient who underwent the May-Husni procedure for the treatment of femoral vein obstruction secondary to a stab wound with a 24-year follow-up. Method(s): Case report. Result(s): A 37-year-old male was stabbed in the left groin causing major bleeding and was operated on immediately 8 years ago. Since then he complained of edema, pigmentation, dermatofibrosis and recurrent ulcers in the left lower limb. Phlebography revealed femoral vein occluded from Hunter's canal to the saphenofemoral junction, obstruction of femoral vein, insufficient leg perforators, collateral venous circulation;the great saphenous vein (GSV) and external iliac vein were patent. He was operated on in 1997 and the left GSV was anastomosed to the popliteal vein above the knee (May-Husni procedure). The ulcers healed after 3 months with the help of compression therapy. After 18 months ulcer recurred. Echo color-doppler (ECD) showed four dilated perforating veins and patent saphenopopliteal anastomosis. Endoscopic subfascial perforation surgery (SEPS) was performed: The ulcer healed after 15 days. In 2019, another ulcer recurrence. During these 20 years patient became obese, diabetic and hypertensive. The ECD showed the saphenopopliteal anastomosis patent and GSV dilatated (11.4 mm) and insufficient with an insufficient dilated tributary in the middle third of the thigh finding several leg varicose tributaries.Ultrasound-guided foam sclerotherapy (UGFS) was performed under pharmacological prophylaxis for deep vein thrombosis (DVT) followed by compression therapy. The ulcer healed after one month. Patient was followed up until 2021 when he died of COVID-19. Conclusion(s): The ligation of veins in the deep venous system (DVS) can trigger severe manifestation and segmental obstructions should be restored;these restorations may have a high success rate and are durable;the patient must be accompanied throughout his life and treated as soon as the first signs of chronic venous disease appear.

Non-drug treatments for bronchiectasis

In recent decades, attention to lung diseases associated with bronchiectasis has increased significantly. Despite the availability of modern effective therapy methods, primarily inhalation therapy, the problems of improving mucociliary clearance, reducing hypersecretion in pathologically deformed bronchi do not lose relevance. In patients with bronchiectasis, cystic fibrosis, COPD with bronchiectasis, methods of kinesitherapy to improve lung drainage function come to the fore. One of modern effective methods of kinesitherapy is the use of simulators with positive expiratory pressure. This includes the PARI O-PEP and the PARI PEP S system. These simulators are effective and easy to use. The PARI PEP S system is attached to a nebulizer and the patient can perform basic mucolytic therapy with exhaled resistance, which is more effective in influencing lung drainage function. The use of expiratory simulators is even more effective if included in a pulmonary rehabilitation course, conducted in conjunction with the improvement of breathing pattern (breathing pattern) through the use of aspiratory simulators, with training of the upper and lower muscle groups that are affected by chronic infectious process. The use of hardware methods to improve lung drainage function, such as vibration and compression therapy, is important to manage exacerbations of bronchiectasis. Due to the pandemic of new coronavirus infection (COVID-19), it is necessary to prevent worsening of the course or exacerbation of lung diseases associated with bronchiectasis, so the daily use of physical training, aspiration training and expiratory exercise machines is essential. © 2022, Remedium Group Ltd. All rights reserved.

Conference Report: LINK for Wound Healing Congress 2021

The third LINK for Wound Healing Congress, powered by HARTMANN in partnership with Wounds International, took place in a virtual format on October 14-15, 2021. The aim was to deliver an informative educational experience and offer attendees the opportunity to learn about recent developments in wound management and discuss clinical best practice.