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Preclinical testing of expired antivenoms and its uses in real-world experience: a systematic review
  1. Sutinee Soopairin,
  2. Chanthawat Patikorn,
  3. Suthira Taychakhoonavudh
  1. Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
  1. Correspondence to Dr Suthira Taychakhoonavudh, Department of Social and Administrative Pharmacy, Chulalongkorn University Faculty of Pharmaceutical Sciences, Bangkok 10330, Thailand; suthira.t{at}


Introduction Limited access to antivenoms is a global challenge in treating snakebite envenoming. In emergency situations where non-expired antivenoms are not readily available, expired antivenoms may be used to save lives with the risk of deteriorating quality, efficacy and safety. Therefore, we aimed to systematically review and summarise the sparse preclinical evidence of neutralising efficacy of expired antivenoms and real-world experience of using expired antivenoms in humans.

Methods We searched for articles published until 1 March 2023 in PubMed, Scopus, Web of Science and Embase. Studies demonstrating the preclinical studies evaluating expired antivenoms or studies describing the real-world experience of using expired antivenoms were included. Narrative synthesis was applied to summarise the evidence of expired antivenoms.

Results Fifteen studies were included. Ten were preclinical studies and five were real-world experiences of using expired antivenoms in humans. The expired duration of antivenoms in the included studies ranged from 2 months to 20 years. The quality of expired antivenoms was evaluated in one study, and they met the standard quality tests. Five studies demonstrated that the expired antivenoms’ immunological concentration and venom-binding activity were comparable to non-expired ones but could gradually deteriorate after expiration. Studies consistently exhibited that expired antivenoms, compared with non-expired antivenoms, were effective when stored in proper storage conditions. The safety profile of using expired antivenoms was reported in two included studies. However, it was inconclusive due to limited information.

Conclusion Even though the quality and efficacy of expired antivenoms are comparable to non-expired antivenoms in preclinical studies, the information is limited in terms of real-world experiences of using expired antivenoms and their safety. Therefore, the use of expired antivenoms may be generally inconclusive due to scarce data. Further investigations may be needed to support the extension of antivenoms’ expiration date according to their potential efficacy after expiration.

  • Systematic Review
  • tropical medicine
  • envenomation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Gene Yong-Kwang Ong

  • Contributors Conceptualisation: CP, ST. Data curation: SS. Formal analysis: SS. Funding acquisition: ST. Investigation: SS, CP, ST. Methodology: SS, CP, ST. Project administration: CP, ST. Resources: ST. Validation: SS, CP, ST. Guarantor: ST. Writing—original draft preparation: SS. Writing—review and editing: SS, CP, ST.

  • Funding This study is supported by Ratchadapiseksompotch Fund Chulalongkorn University (grant number: ReinUni_65_02_33_09).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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