Triple therapy for calciphylaxis: A retrospective analysis of sodium thiosulfate, iloprost, and anticoagulation

BACKGROUND: Calciphylaxis is a severe condition with no established therapy, characterized by painful skin ulcerations and necrosis resulting from occlusion of small blood vessels. Given the high mortality rate, effective treatment strategies are urgently needed. We hypothesize that a combination of sodium thiosulphate with the prostaglandin analog iloprost and a low-molecular-weight heparin may be a beneficial treatment option for calciphylaxis. PATIENTS AND METHODS: In a retrospective data analysis, 19 patients with calciphylaxis were included who were treated in our clinic between 2019 and 2023. Demographic factors, clinical symptoms, comorbidities, laboratory results, histology, and treatment-related factors were collected. RESULTS: 68.4% were female and mean age was 67.8 years. In 63% of cases, a combination therapy consisting of sodium thiosulfate, iloprost and anticoagulation was used. In a cohort of 12 patients who underwent at least 2 treatment cycles complete healing occurred in 75.0% of cases and partial improvement in 25.0%. The median time to healing was 3.0 treatment cycles. The median duration until complete pain relief was 2.5 treatment cycles. CONCLUSIONS: In our cohort, a combination therapy consisting of sodium thiosulfate, iloprost, and anticoagulation was associated with favorable treatment response, good tolerability, improved wound healing, and pain relief.