Original Investigation
December 4, 2023
Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial
Érica da Silva Carvalho, Andrea Renata do Nascimento Souza, Dessana Francis Chehuan Melo, et al
JAMA Intern Med. Published online December 4, 2023. doi:10.1001/jamainternmed.2023.6538
Question What is the feasibility, safety, and efficacy of low-level laser therapy (LLLT) in reducing local manifestations of Bothrops atrox envenomations?
Findings In this double-blind randomized clinical trial that included 60 adults, the findings show that LLLT use was feasible and effective in reducing myonecrosis and the local inflammatory process caused by B atrox envenomations.
Meaning Results support the use of LLLT in combination with antivenom to treat snakebites.
Abstract
Importance Bothrops venom acts almost immediately at the bite site and causes tissue damage.
Objective To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations.
Design, Setting, and Participants This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022.
Intervention The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point.
Main Outcomes and Measures Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients’ acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients’ discharge. Pvalues for outcomes were adjusted with Bonferroni correction.
Results A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed.
Conclusions and Relevance The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations.
Trial Registration Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf
