Article
作者: Duranteau, Jacques ; Hollinger, Alexa ; Zarbock, Alexander ; Baudrillart, Ludmila ; Kluge, Stefan ; Karakas, Mahir ; Hadjam, Tassadit ; Contou, Damien ; Abeud, Lila-Fariza ; Vuillard, Constance ; Herafa, Isabelle ; Berton, Laure ; Oueslati, Haikel ; Chalot, Coralie ; Godet, Thomas ; Weiss, Emmanuel ; Gielens, Leslie ; Asfar, Pierre ; Duchambon, Anne-Aurore ; Zimmermann, Jens ; Dujardin, Marie-France ; Evrard, Bruno ; Deye, Nicolas ; Mercier, Emmanuelle ; Castanares, Diego ; Jorens, Philippe ; Fedou, Anne-Laure ; Dugernier, Thierry ; Hartmann, Oliver ; Montiel, Virginie ; Bauer, Michael ; Jourdaine, Clement ; Prevost, Céline ; Gèrards, Ludovic ; Vignon, Philippe ; Pottecher, Julien ; van Zanten, Arthur R. H. ; Helms, Julie ; Wittebole, Xavier ; Goudelin, Marine ; Desachy, Arnaud ; Dormans, Tom ; Engels, Perrine ; Cerlinskaite, Kamile ; Fournier, Marie-Celine ; Laterre, Pierre-François ; Huberlant, Vincent ; Neuschwander, Arthur ; Merdji, Hamid ; Lascarrou, Jean-Baptiste ; Monnier, Alexandra ; Lacherade, Jean-Claude ; Meziani, Ferhat ; Bergmann, Andreas ; Louadah, Badr ; Renard, Suzanne ; Schuerholz, Tobias ; François, Bruno ; Bourzeix, Paul ; Clere-Jehl, Raphaël ; Legrand, Matthieu ; Beishuizen, Albertus ; Marx, Gernot ; Berghe, Caroline ; Chousterman, Benjamin ; Pickkers, Peter ; Javanainen, Tuija ; Plantefève, Gaëtan ; Hantson, Phillipe ; Vermeijden, Wytze ; Daix, Thomas ; Richter, Kathleen ; Pars, Melanie ; Demiselle, Julien ; Hoiting, Oscar ; Maëlle, Martin ; Gay, Alexandra ; Collienne, Christine ; Mebazaa, Alexandre
PURPOSE:Investigate safety and tolerability of adrecizumab, a humanized monoclonal adrenomedullin antibody, in septic shock patients with high adrenomedullin.
METHODS:Phase-2a, double-blind, randomized, placebo-controlled biomarker-guided trial with a single infusion of adrecizumab (2 or 4 mg/kg b.w.) compared to placebo. Patients with adrenomedullin above 70 pg/mL, < 12 h of vasopressor start for septic shock were eligible. Randomization was 1:1:2. Primary safety (90-day mortality, treatment emergent adverse events (TEAE)) and tolerability (drug interruption, hemodynamics) endpoints were recorded. Efficacy endpoints included the Sepsis Support Index (SSI, reflecting ventilator- and shock-free days alive), change in Sequential-related Organ Failure Assessment (SOFA) and 28-day mortality.
RESULTS:301 patients were enrolled (median time of 8.5 h after vasopressor start). Adrecizumab was well tolerated (one interruption, no hemodynamic alteration) with no differences in frequency and severity in TEAEs between treatment arms (TEAE of grade 3 or higher: 70.5% in the adrecizumab group and 71.1% in the placebo group) nor in 90-day mortality. Difference in change in SSI between adrecizumab and placebo was 0.72 (CI -1.93-0.49, p = 0.24). Among various secondary endpoints, delta SOFA score (defined as maximum versus minimum SOFA) was more pronounced in the adrecizumab combined group compared to placebo [difference at 0.76 (95% CI 0.18-1.35); p = 0.007]. 28-day mortality in the adrecizumab group was 23.9% and 27.7% in placebo with a hazard ratio of 0.84 (95% confidence interval 0.53-1.31, log-rank p = 0.44).
CONCLUSIONS:Overall, we successfully completed a randomized trial evaluating selecting patients for enrolment who had a disease-related biomarker. There were no overt signals of harm with using two doses of the adrenomedullin antibody adrecizumab; however, further randomized controlled trials are required to confirm efficacy and safety of this agent in septic shock patients.