OBJECTIVE: Group IIA secretory phospholipase A2 (sPLA2-IIA), released during inflammation, is increased in severe sepsis, and plasma levels are inversely related to survival. In a previous study, a selective inhibitor of sPLA2-IIA (LY315920NA/S-5920) was well tolerated and appeared to improve survival in a subgroup of patients who received the drug within 24 hrs of first sepsis-induced organ failure. This study was designed to determine whether improvement in survival could be confirmed in a larger patient population meeting the characteristics of that subgroup. DESIGN: Multicenter, double-blind, placebo-controlled, parallel-group clinical trial of LY315920NA/S-5920 in patients with severe sepsis. SETTING: Seventy-five institutions worldwide. PATIENTS: A total of 373 patients with at least two sepsis-induced organ failures. INTERVENTIONS: Patients were randomized 1:1 to receive LY315920NA/S-5920 (target plasma concentration of 800 ng/mL; n = 188) or placebo (n = 185). Study medication was administered as a continuous intravenous infusion for 168 hrs. MEASUREMENTS AND MAIN RESULTS: The study was terminated after data on 250 patients suggested a significant improvement in 28-day all-cause mortality would not be found if the trial continued as planned. The mortality rate was 39.4% in the LY315920NA/S-5920 group, compared with 31.9% in the placebo group (p = .092). The negative trend in mortality was most pronounced among patients with cardiovascular failure at baseline (41.6% vs. 28.7%; p = .008) and patients whose culture data at baseline were negative (42.9% vs. 22.7%; p = .045). The negative trend in mortality is not explained by adverse events, microbiology, or laboratory data. CONCLUSIONS: Continuous 7-day infusion of an inhibitor of sPLA2-IIA had no beneficial effect on 28-day all-cause mortality among severe sepsis patients with at least two organ failures. This study did not confirm earlier promising subgroup results with LY315920NA/S-5920, which provides a reminder that subgroup effects should be viewed cautiously, especially when primary effects are not significant.
RCT Entities:
OBJECTIVE: Group IIA secretory phospholipase A2 (sPLA2-IIA), released during inflammation, is increased in severe sepsis, and plasma levels are inversely related to survival. In a previous study, a selective inhibitor of sPLA2-IIA (LY315920NA/S-5920) was well tolerated and appeared to improve survival in a subgroup of patients who received the drug within 24 hrs of first sepsis-induced organ failure. This study was designed to determine whether improvement in survival could be confirmed in a larger patient population meeting the characteristics of that subgroup. DESIGN: Multicenter, double-blind, placebo-controlled, parallel-group clinical trial of LY315920NA/S-5920 in patients with severe sepsis. SETTING: Seventy-five institutions worldwide. PATIENTS: A total of 373 patients with at least two sepsis-induced organ failures. INTERVENTIONS:Patients were randomized 1:1 to receive LY315920NA/S-5920 (target plasma concentration of 800 ng/mL; n = 188) or placebo (n = 185). Study medication was administered as a continuous intravenous infusion for 168 hrs. MEASUREMENTS AND MAIN RESULTS: The study was terminated after data on 250 patients suggested a significant improvement in 28-day all-cause mortality would not be found if the trial continued as planned. The mortality rate was 39.4% in the LY315920NA/S-5920 group, compared with 31.9% in the placebo group (p = .092). The negative trend in mortality was most pronounced among patients with cardiovascular failure at baseline (41.6% vs. 28.7%; p = .008) and patients whose culture data at baseline were negative (42.9% vs. 22.7%; p = .045). The negative trend in mortality is not explained by adverse events, microbiology, or laboratory data. CONCLUSIONS: Continuous 7-day infusion of an inhibitor of sPLA2-IIA had no beneficial effect on 28-day all-cause mortality among severe sepsispatients with at least two organ failures. This study did not confirm earlier promising subgroup results with LY315920NA/S-5920, which provides a reminder that subgroup effects should be viewed cautiously, especially when primary effects are not significant.
Authors: Michael A Flierl; Daniel Rittirsch; Sebastian Weckbach; Markus Huber-Lang; Kyros Ipaktchi; Peter A Ward; Philip F Stahel Journal: Ann Intensive Care Date: 2011-12-30 Impact factor: 6.925
Authors: Nilda M Muñoz; Angelo Y Meliton; Lucille N Meliton; Steven M Dudek; Alan R Leff Journal: Am J Physiol Lung Cell Mol Physiol Date: 2009-03-13 Impact factor: 5.464
Authors: Lawrence K Lee; Katherine J Bryant; Romaric Bouveret; Pei-Wen Lei; Anthony P Duff; Stephen J Harrop; Edwin P Huang; Richard P Harvey; Michael H Gelb; Peter P Gray; Paul M Curmi; Anne M Cunningham; W Bret Church; Kieran F Scott Journal: J Biol Chem Date: 2013-03-12 Impact factor: 5.157