[Immunotherapy using the anti-endotoxin antibody HA-1A (Centoxin) in patients with sepsis syndrome; fair results following protocol selection of patients].

Abstract

OBJECTIVE:

Evaluation of HA-1A treatment in patients with the sepsis syndrome.

DESIGN:

Descriptive.

SETTING:

Department of intensive care, Academic Medical Centre, Amsterdam.

PATIENTS AND METHODS:

Intensive-care patients with the sepsis syndrome and shock or organ failure with a presumptive diagnosis of Gram-negative infection were eligible for treatment with HA-1A. We analysed and compared the results with those of the double-blind, randomized HA-1A study by Ziegler et al.

RESULTS:

Between May 1991 and March 1992, 27 patients were treated with HA-1A. The mortality rate was 59% (16/27). Among the 11 patients with a Gram-negative bacteraemia mortality was 7/11, much higher than in the Ziegler study (30%). In comparison with the HA-1A study we selected sicker patients: the mean APACHE II score was higher, 93% of our patients were in shock and 85% had organ failure. More patients presented with an intra-abdominal sepsis and mortality in this group was very high (11/14). In patients with a Gram-negative bacteraemia the delay between the onset of the sepsis syndrome and the administration of HA-1A was longer (median 22 h versus 14.3 h in the Ziegler study, mean 30 versus 20 h).

CONCLUSION:

HA-1A does not appear to be beneficial in critically ill patients with a longstanding sepsis syndrome, especially not if an intra-abdominal sepsis is apparent. Therefore, we decided not to use H-1A until additional data become available. Additional objective inclusion criteria are needed to improve the identification of the patient group that may benefit from treatment with HA-1A.

• Authors: L G Costongs, P Speelman, J J van Lieshout, S J van Deventer, M J Lubbers, H G Schipper
• Journal: Nederlands tijdschrift voor geneeskunde (Ned Tijdschr Geneeskd) Vol. 137 Issue 7 Pg. 355-60 (Feb 13 1993) ISSN: 0028-2162 [Print] Netherlands
• Vernacular Title: Immunotherapie met de anti-endotoxine-antistof HA-1A (Centoxin) bij patiënten met het sepsissyndroom; matige resultaten na geprotocolleerde selectie van patiënten.
• PMID: 8437634 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Endotoxins
• Immunoglobulin G
• nebacumab

Topics

• Adolescent
• Adult
• Aged
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Clinical Trials as Topic
• Endotoxins (immunology)
• Female
• Gram-Negative Bacterial Infections (complications, therapy)
• Humans
• Immunoglobulin G (therapeutic use)
• Male
• Middle Aged
• Multiple Organ Failure (therapy)
• Sepsis (etiology, mortality, therapy)
• Severity of Illness Index
• Shock, Septic (therapy)