Rhenium (Sup186/Supre) Sulfide Colloid

What it is and how it works

Rhenium-186 sulfide colloid consists of particles labelled with rhenium-186, a beta emitter (with some gamma emission) with a half-life of about 3.7 days and a tissue penetration suited to medium-sized joints. After intra-articular injection, the particles are taken up by the synovial lining, whose irradiation reduces inflammation and effusion.

Indications

Radiosynovectomy of medium-sized joints (e.g. shoulder, elbow, wrist, ankle, hip) affected by chronic inflammatory synovitis, such as rheumatoid arthritis, when other treatments have failed.

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, usually with imaging guidance.

Contraindications

Pregnancy and breast-feeding, local skin infection or lesion, ruptured Baker’s cyst and extensive joint destruction.

Warnings and precautions

Extra-articular leakage can cause radiation necrosis; the needle tract should be flushed and the joint immobilised for about 48 hours. 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.