Hyperbaric oxygen therapy improves survival and wound healing outcomes in calciphylaxis patients: JAAD

The retrospective study of 93 calciphylaxis patients revealed that those treated with hyperbaric oxygen therapy in addition to IV STS experienced significantly longer survival time versus those treated with IV STS only, specifically, those patients classified as having non-nephrogenic calciphylaxis. Also, there was a positive correlation between the number of HBOT sessions and better wound-healing outcomes.

The findings from the retrospective review of outcomes after hyperbaric oxygen therapy for calciphylaxis treatment were published in the Journal of the American Academy of Dermatology.

Calciphylaxis is a thrombotic vasculopathy characterized by painful necrotic ulcerations, Despite high mortality, no therapies have been approved by the FDA (Food and Drug Administration). Bianca Biglione, Department of Dermatology, Massachusetts General Hospital; Boston, MA, and colleagues aimed to compare mortality and wound healing outcomes in patients treated with hyperbaric oxygen therapy in addition to IV sodium thiosulfate versus patients who received IV STS only. Findings were stratified by dialysis status and modality.

93 patients were randomly assigned to the control group (IV STS; n=57) and the treatment group (HBOT + IV STS; n=36). Mortality data was analyzed with traditional survival analyses and Cox proportional hazard models. Analysis of longitudinal wound outcomes was done with mixed effects modelling.

The study led to the following findings:

· Univariate survival analyses showed that the full HBOT treatment was associated with a significantly longer survival time.

· Increasing the number of HBOT sessions was associated with improved mortality outcomes, with 1, 5, 10 and 20 sessions yielding decreasing hazard ratios.

· There was also a significant positive association between the increasing number of HBOT sessions and increased wound score.

The main limitation of the study was that the data collection was retrospective.

"Hyperbaric oxygen therapy may have a role in the treatment of calciphylaxis with benefits demonstrated in both wound healing and mortality," the researchers wrote. " There is a need for larger prospective studies to identify which patients would most benefit from this intervention."

Reference:

Biglione B, Cucka B, Iriarte C, Locascio JJ, Goldfarb JW, Gutium A, Lima XT, Kroshinsky D. A retrospective review of outcomes after hyperbaric oxygen therapy for the treatment of calciphylaxis. J Am Acad Dermatol. 2023 Aug 14:S0190-9622(23)02495-7. doi: 10.1016/j.jaad.2023.07.1031. Epub ahead of print. PMID: 37586460.