1. Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study)
- Author
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Harald Lapp, Benjamin Dälken, Karl Werdan, J.M. Sirvent, Matthias Kochanek, Matt P. Wise, Antonio Artigas, Gonzalo Sirgo Rodríguez, Stefan Kluge, Jörg Schüttrumpf, Andrea Wartenberg-Demand, Henning Ebelt, Tobias Welte, Juan Bonastre Mora, R. Phillip Dellinger, Sebastian Nuding, Mervyn Singer, Monika Mayer, Jordi Almirall, Miguel Sánchez García, Gabriele Wöbker, Steven M. Opal, Jose Ignacio Ayestarán, Jean Louis Vincent, Antoni Torres, Reimer Riessen, Ricard Ferrer, Miguel Ferrer, Axel Kempa, Iris Bobenhausen, Kai Zacharowski, Ignacio Martin-Loeches, Henrik Reschreiter, Ute Achtzehn, Daniele Wolf, David Brealey, Ulrike Wippermann, Patrick Dubovy, Bernd H. Belohradsky, Jörg Brederlau, Francisco Álvarez-Lerma, Patrick Langohr, and Manu Shankar-Hari
- Subjects
Male ,Soins intensifs réanimation ,humanos ,Critical Care and Intensive Care Medicine ,Procalcitonin ,Trimodulin ,law.invention ,0302 clinical medicine ,Community-acquired pneumonia ,Seven-Day Profile Publication ,law ,Clinical endpoint ,Medicine ,030212 general & internal medicine ,mediana edad ,Aged, 80 and over ,anciano ,biology ,Respiration ,resultado del tratamiento ,respiración ,Middle Aged ,Intensive care unit ,Combined Modality Therapy ,3. Good health ,Anti-Bacterial Agents ,Community-Acquired Infections ,Immunoglobulin Isotypes ,Treatment Outcome ,Tolerability ,Female ,antibacterianos ,medicine.medical_specialty ,Severe community-acquired pneumonia ,isotipos de inmunoglobulinas ,Placebo ,03 medical and health sciences ,Double-Blind Method ,Internal medicine ,Humans ,Immunologic Factors ,factores inmunitarios ,método con doble ocultación ,Polyclonal antibody ,Aged ,Add-on therapy ,lactante ,business.industry ,C-reactive protein ,Infant, Newborn ,Infant ,infecciones adquiridas en la comunidad ,neumonía ,030208 emergency & critical care medicine ,Pneumonia ,tratamiento combinado ,medicine.disease ,Respiration, Artificial ,Immunoglobulin M ,biology.protein ,business - Abstract
Purpose: The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP). Methods: In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L). Results: Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58–78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline. Conclusions: No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation. Trial registration: NCT01420744., 0, SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2018