NEJM Audio Summary - May 31, 2012

Excerpted Script

0:46| "Drotrecogin Alfa (Activated) in Adults with Septic Shock" by V. Marco Ranieri, from Università di Torino, Turin, Italy. 0:46| The efficacy of drotrecogin alpha (activated) (DrotAA) for sepsis has been controversial. This study tested the hypothesis that DrotAA, as compared with placebo, would reduce mortality in patients with septic shock. At 28 days, 223 of 846 patients (26.4%) in the DrotAA group and 202 of 834 (24.2%) in the placebo group had died. At 90 days, 34.1% in the DrotAA group and 32.7% in the placebo group had died. Among patients with severe protein C deficiency at baseline, 28.7% in the DrotAA group had died at 28 days, as compared with 30.8% in the placebo group. Similarly, rates of death at 28 and 90 days were not significantly different in other predefined subgroups, including patients at increased risk for death. Serious bleeding during the treatment period occurred in 10 patients in the DrotAA group and 8 in the placebo group. DrotAA did not significantly reduce mortality at 28 or 90 days, as compared with placebo, in patients with septic shock.
2:17| Richard Wenzel, from the Virginia Commonwealth University, Richmond, writes in the editorial that this large and well-conducted study should end any further pursuit of a niche for DrotAA in the treatment of sepsis. The investigators' findings provide a sad chapter in the noble quest for a truly effective adjunct for the treatment of septic shock. This setback should inspire a redoubling of efforts to seek new approaches to treatment that are based on a more crystalline view of the biology of sepsis.

日本語では、呼吸器内科医「敗血症性ショックにおけるザイグリスdrotrecogin alfa (DrotAA)は死亡率改善もたらさず」とか、ID CONFERENCEの「さようならプロテインC」とかも