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Nephrology Education

Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal

Viktor Arelin, Julius J. Schmidt, Nathalie Kayser, W. Nikolaus Kühn-Velten, Hendrik Suhling, Gabriele Eden, and Jan T. Kielstein

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Volume 85 (2016) p. 353 - 357

Abstract

Clinical Nephrology, Vol. 85 – No. 6/2016 (353-357)

Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal

Viktor Arelin¹, Julius J. Schmidt¹, Nathalie Kayser¹, W. Nikolaus Kühn-Velten², Hendrik Suhling³, Gabriele Eden¹#⁴, and Jan T. Kielstein¹#⁴

¹Department of Nephrology and Hypertension, Hannover Medical School, Hannover, ²Medical Laboratory of Bremen, Bremen, ³Department of Respiratory Medicine, Hannover Medical School, Hannover, and ⁴Medical Clinic V, Nephrology and Hypertension, Academic Hospital Braunschweig, Braunschweig, Germany
The synthetic opioid methadone hydrochloride has a low molecular weight of 346 D, a high volume of distribution (4 – 7 L/kg), and is lipophilic. It is used as an analgesic and for the maintenance treatment of opiate dependence. In drug addicts, methadone is frequently involved in mixed intoxications that can lead to death. Here we present the case of a drug addict in whom a high cut-off dialysis membrane together with extended dialysis was used in the setting of suspected overdose and acute kidney injury. Although the observed dialyzer plasma clearance (31.5 mL/min) and reduction ratio (38%) were higher than previously reported for standard hemodialysis, the total amount of methadone in the spent dialysate after 1 extended dialysis session was quite low. Hence, even extended dialysis with a high cut-off membrane does not seem to offer a clinically relevant benefit in the setting of overdose for enhanced methadone removal. On the other hand, in patients undergoing high cut-off dialysis for the removal of light chains, methadone could still be used as an analgesic without an additional dose after high cut-off hemodialysis.Correspondence to:
Jan T. Kielstein, MD
Medical Clinic V, Academic Teaching Hospital Braunschweig
Salzdahlumer Str. 90, 38126, Braunschweig, Germany
Email: [email protected]

Original

Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN)

Alexandra Lenoir, Roland Buhl, Carlo Muemmler, Jürgen Behr, Rainer Ehmann, Eckard Hamelmann, Anette Holtdirk, Marco Idzko, Margret Jandl, Frank Kaessner, Olaf Schmidt, Christian Schulz, Dirk Skowasch, Hendrik Suhling, Christian Taube, Stephanie Korn, Katrin Milger; and GAN investigators

Volume 10 (2026) p. 158 - 169

Abstract

Allergologie select, Vol. 10/2026 (158-169)

Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN)

Alexandra Lenoir¹, Roland Buhl², Carlo Muemmler¹,¹⁶, Jürgen Behr¹, Rainer Ehmann³, Eckard Hamelmann⁴, Anette Holtdirk⁵, Marco Idzko⁶, Margret Jandl⁷, Frank Kaessner⁸, Olaf Schmidt⁹, Christian Schulz¹⁰, Dirk Skowasch¹¹, Hendrik Suhling¹², Christian Taube¹³, Stephanie Korn¹⁴, Katrin Milger¹,¹⁵; and GAN investigators

¹Department of Medicine V, LMU University Hospital, Comprehensive Pneumology Center (CPC), Member of the German Center of Lung Research (DZL), LMU Munich, Munich, ²Mainz University Hospital, Pulmonary Department, Mainz, ³Ambulante Pneumologie mit Allergiezentrum, Stuttgart, ⁴Kinderzentrum Bethel, Evangelisches Klinikum Bethel, University Bielefeld, Bielefeld, ⁵RQMplus Germany, Ahlen, Germany, ⁶Department of Pneumology, University Hospital Vienna AKH, Medical University of Vienna, Vienna, Austria, ⁷Hamburger Institut für Therapieforschung GmbH, Hamburg, ⁸Ambulantes Zentrum für Lungenkrankheiten und Schlafmedizin, Cottbus, ⁹Pneumologie Mittelrhein und Studienzentrum KPPK, Bendorf am Rhein, ¹⁰Clinic and Polyclinic of Internal Medicine, Department of Pneumology, University Hospital Regensburg, University of Regensburg, Regensburg, ¹¹Department of Internal Medicine II - Pneumology, University Hospital Bonn, Bonn, ¹²Pneumologicum Hannover, Hanover, ¹³Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, ¹⁴IKF Pneumologie Mainz and Thoraxklinik Heidelberg, Mainz and Heidelberg, Germany, ¹⁵Division of Respiratory Medicine, Department of Internal Medicine, Lung Research Cluster, Medical University of Graz, Graz, Austria, and ¹⁶Institute of Lung Health and Immunity (LHI), Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Center of Lung Research (DZL), Munich, Germany
With six biologics available to treat severe asthma in 2025, choosing the optimal initial therapy and deciding to which other biologic to switch in case of insufficient benefit is challenging. To better understand patients’ characteristics depending on the chosen biologic and patterns of switch, we evaluated adult patients with severe asthma from the GAN registry who were biologic-naïve at baseline. Between 2011 and 2024, 2,649 patients with severe asthma newly received a biologic, 26% anti-interleukin-5 receptor (IL5R), 25% anti-IL5, 16% anti-IL4R, 24% anti-immunoglobulin E (IgE), and 9% anti-thymic stromal lymphopoietin (TSLP). Distribution of biologics varied between time periods, reflecting their availability over time. Patients treated with anti-IgE were youngest at asthma diagnosis (mean 26 years) and had the highest rates of allergic comorbidities (80%). Blood eosinophils were highest in patients receiving anti-IL5R (median 433/µL) and lowest in those receiving anti-TSLP (median 159/µL), while FeNO was highest in patients treated with anti-IL5, anti-IL5R, or anti-IL4R (median 39, 38, and 35 ppb, respectively). 14.3% (n = 378) of patients were switched from the first biologic to a different one. The most frequent switch constellations were anti-IL5 to anti-IL5R, anti-IL5R to anti-IL4R, and anti-IL5 to anti-IL4R. After a switch, depending on the constellation up to 46% of patients reached remission. Phenotyping patients with severe asthma determines the choice of biologic therapy in real-world practice. Choice and switch of biologic have evolved over time influenced by availability of different drugs. Our analysis supports the practice of switching to a different biologic in case of insufficient initial response.Correspondence to:
Katrin Milger, MD, Division of Respiratory Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
Email: [email protected]

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