Rhenium (188re) Sulfide Colloid

What it is and how it works

Rhenium-188 sulfide colloid consists of particles labelled with rhenium-188, a beta and gamma emitter with a half-life of about 17 hours. After intra-articular injection the particles are phagocytosed by synovial cells, and the beta radiation ablates inflamed synovium (radiosynoviorthesis).

Indications

Radiosynovectomy of joints with chronic synovitis (e.g. rheumatoid arthritis, haemophilic arthropathy) unresponsive to conventional therapy; investigational and local uses include other locoregional therapies.

Dosage and administration (summary)

Dosing is individualised by the nuclear medicine specialist according to protocol and joint size; given by intra-articular injection under aseptic conditions, often with imaging guidance.

Contraindications

Pregnancy and breast-feeding, local infection or skin lesion at the injection site, ruptured Baker’s cyst and extensive joint destruction with bone loss.

Warnings and precautions

Extra-articular leakage may cause radiation necrosis of tissue; the joint should be immobilised for about 48 hours after injection to reduce leakage. Radiation-protection measures are required.

Pregnancy

Therapeutic radiopharmaceuticals are contraindicated in pregnancy; pregnancy must be excluded before administration.

Storage and supply

Store in appropriate lead shielding in accordance with national regulations for radioactive materials and the manufacturer’s instructions; use within the stated shelf-life after calibration.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.