Double-blind randomised controlled trial of monoclonal antibody to human tumour necrosis factor in treatment of septic shock

Edward Abraham, Antonio Anzueto, Guillermo Gutierrez, Sidney Tessler, Gerry San Pedro, Richard Wunderink, Anthony Dal Nogare, Stanley Nasraway, Steve Berman, Robert Cooney, Howard Levy, Robert Baughman, Mark Rumbak, R. Bruce Light, Lona Poole, Randy Allred, John Constant, James Pennington, Steven Porter

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550 Scopus citations

Abstract

Background. Despite the availability of potent antibiotics and intensive care, mortality rates from septic shock are 40-70%. We assessed the safety and efficacy of murine monoclonal antibody to human tumour necrosis factor α (TNFα MAb) in the treatment of septic shock. Methods. In a randomised, multicentre, double-blind, placebo-controlled clinical trial in 105 hospitals in the USA and Canada, we randomly assigned 1879 patients a single infusion of 7.5 mg/kg TNFα MAb (n = 949) or placebo (0.25% human serum albumin n = 930). Our main outcome measurement was the rate of all-cause mortality at 28 days. Findings. 382 (40.3%) of 948 patients who received TNFα MAb and 398 (42.8%) of 930 who received placebo had died at 28 days (95% CI -0.02 to 0.07, p = 0.27). We found no association between therapy with TNFα MAb and increased rapidity in reversal of initial shock or prevention of subsequent shock. Similarly, baseline plasma interleukin-6 concentrations of more than 1000 pg/mL or detectable circulating TNF concentrations were not associated with improvement in survival after TNFα MAb therapy. Coagulopathy but not other organ or system failures, was significantly decreased in the TNFα MAb group compared with placebo (day 7, p < 0.001; day 28, p = 0.005). Serious adverse events were reported in 55.2% of patients given placebo and 54.1% in the TNFα MAb group. Interpretation. We did not find an improvement in survival after septic shock with TNFα MAb. Therapy not solely dependent on TNFα blockade may be required to improve survival.

Original languageEnglish (US)
Pages (from-to)929-933
Number of pages5
JournalLancet
Volume351
Issue number9107
DOIs
StatePublished - Mar 8 1998

ASJC Scopus subject areas

  • Medicine(all)

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    Abraham, E., Anzueto, A., Gutierrez, G., Tessler, S., San Pedro, G., Wunderink, R., Dal Nogare, A., Nasraway, S., Berman, S., Cooney, R., Levy, H., Baughman, R., Rumbak, M., Light, R. B., Poole, L., Allred, R., Constant, J., Pennington, J., & Porter, S. (1998). Double-blind randomised controlled trial of monoclonal antibody to human tumour necrosis factor in treatment of septic shock. Lancet, 351(9107), 929-933. https://doi.org/10.1016/S0140-6736(05)60602-2