ArticleCritical care (London, England)2008
Drotrecogin alfa (activated): real-life use and outcomes for the UK.
Article in Critical care (London, England), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Propensity scores in intensive care and anaesthesiology literature: a systematic review.Intensive care medicine · 2010Pooled it
- How the context of reception affects the meaning of RCT evidence.Health (London, England : 1997) · 2024Trial
- Pharmacogenomic biomarkers do not predict response to drotrecogin alfa in patients with severe sepsis.Annals of intensive care · 2018Article
- The efficacy of activated protein C for the treatment of sepsis: incorporating observational evidence with a Bayesian approach.BMJ open · 2015Article
- Why activated protein C was not successful in severe sepsis and septic shock: are we still tilting at windmills?Current infectious disease reports · 2013Article
- Evaluation of recombinant activated protein C for severe sepsis at a tertiary academic medical center.Therapeutics and clinical risk management · 2013Article
- Design, conduct, and analysis of a multicenter, pharmacogenomic, biomarker study in matched patients with severe sepsis treated with or without drotrecogin Alfa (activated).Annals of intensive care · 2012Article
- Study protocol: the Back Pain Outcomes using Longitudinal Data (BOLD) registry.BMC musculoskeletal disorders · 2012Article
- Is Drotrecogin alfa (activated) for adults with severe sepsis, cost-effective in routine clinical practice?Critical care (London, England) · 2011Article
- Risk of death and the efficacy of eritoran tetrasodium (E5564): design considerations for clinical trials of anti-inflammatory agents in sepsis.Critical care medicine · 2010Article
- Growing insights into the potential benefits and risks of activated protein C administration in sepsis: a review of preclinical and clinical studies.Biologics : targets & therapy · 2009Article
- The international PROGRESS registry of patients with severe sepsis: drotrecogin alfa (activated) use and patient outcomes.Critical care (London, England) · 2009Article
- Once is not enough: clinical trials in sepsis.Intensive care medicine · 2008Article
- Current role of activated protein C therapy for severe sepsis and septic shock.Current infectious disease reports · 2008Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn March 2001, the results of the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study were published, which indicated a 6.1% absolute reduction in 28-day mortality. Drotrecogin alfa (activated; DrotAA) was subsequently approved for use in patients with severe sepsis.
methodsIn December 2002, critical care units in England, Wales and Northern Ireland were invited to participate in an audit of DrotAA. Data for each infusion of DrotAA were linked to case mix and outcome data from a national audit. Use of DrotAA was described and a nonrandomized comparison of effectiveness was conducted.
results1,292 infusions of DrotAA were recorded in 112 units; 61% commenced during the first 24 hours in the unit. The majority (77%) of patients had three or more organs failing; lung (42%) and abdomen (40%) were the most common primary sites of infection. Crude hospital mortality was high (45%); at 28 days, only 18% had left acute hospital and 19% were still in the unit. For 30%, the full 96-hour infusion was not completed; 24% of infusions were interrupted; 8.1% experienced one or more serious adverse events, of which 77% were serious bleeding events. Of eight relative risks estimated from individually-matched (0.75 to 0.85) and propensity-matched (0.82 to 0.90) controls, seven were consistent with the results of PROWESS. Restricting the analysis to patients receiving DrotAA during the first 24 hours resulted in larger treatment effects (relative risks 0.62 to 0.81). For all matches, similar patterns were seen across subgroups. No effect of DrotAA was seen for two organs failing or lower severity scores, compared with a significant mortality reduction for three or more organs failing or higher severity scores.
conclusionUse of DrotAA was approximately one in 16 for admissions meeting the definition for severe sepsis and with two or more organs failing. Patients receiving DrotAA were younger and more severely ill but were less likely to have serious conditions in their past medical history. Nonrandomized estimates for the effectiveness of DrotAA were consistent with the findings of PROWESS. DrotAA appeared not to be effective in patients with less severe disease.
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