Silver Nitrate-coated versus Standard Indwelling Pleural Catheter for Malignant Effusions: The SWIFT Randomized Trial

Shrager JB et al.

Ann Am Thorac Soc Volume 19, Issue 10, October 2022, Pages 1722-1729

What is the key question?

  • Do silver nitrate-coated indwelling pleural catheters (SNCIPC) improve pleurodesis efficacy compared to standard indwelling pleural catheters (IPC) in patients with recurrent symptomatic malignant pleural effusions (MPE)?

What is the bottom line?

  • SNCIPC is a novel catheter developed with the intention of creating a rapid, effective chemical pleurodesis to allow more frequent and earlier catheter removal.
  • The SWIFT trial was designed as a multicenter, parallel-group, randomized, controlled, patient-blind trial and compared the SNCIPC (n=77) to the standard uncoated IPC (n=37) in patients with recurrent symptomatic MPE without evidence of lung entrapment or significant loculation from 17 secondary or tertiary care hospitals in the United States and 3 in the United Kingdom. Follow-up was conducted until 90 days. The primary outcome measure was pleurodesis efficacy, measured by fluid drainage, at 30 days.
  • The study found that the pleurodesis rates were 12 (32%) of 37 in the control group and 17 (22%) of 77 in the SNCIPC group (rate difference, -0.10; 95% CI, -0.30 to 0.09). The median time-to-pleurodesis was 11 days (interquartile range, 9 to 23) in the control group and 4 days (interquartile range, 2 to 15) in the SNCIPC group. There were no significant difference in the treatment-related adverse event rates between the two groups.

Why read on?

  • This study shows that the SNCIPC did not confer any additional advantage over standard IPC with respect to pleurodesis efficacy and, as such, does not support the wider use of the SNCIPC catheter.