Trial reportPLoS neglected tropical diseases2017
Dose of antivenom for the treatment of snakebite with neurotoxic envenoming: Evidence from a randomised controlled trial in Nepal.
Trial report in PLoS neglected tropical diseases, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01284855 (A Randomized, Double-blind, Clinical Trial of Two Dose Regimens of VINS Polyvalent Antivenom), which is not on this map. Cited by 18 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized, Double-blind, Clinical Trial of Two Dose Regimens of VINS Polyvalent Antivenom (ATC J06AA03) for the Treatment of Snake Bites With Neurotoxic Envenoming in Nepal
Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Outcomes in intervention research on snakebite envenomation: a systematic review.F1000Research · 2022Pooled it
- Clinical outcomes and outcome measurement tools reported in randomised controlled trials of treatment for snakebite envenoming: A systematic review.PLoS neglected tropical diseases · 2021Pooled it
- A Randomized Controlled Trial to Optimize Antivenom Therapy for Carpet Viper (Echis romani)-Envenomed Children in Nigeria.The American journal of tropical medicine and hygiene · 2024Trial
- Association Between Preoperative Calcium Levels and the Occurrence of Postoperative PE in Trauma Patients: A Retrospective Multicenter Cohort Study.World journal of surgery · 2026Article
- Cost of Snakebite and Its Impact on Household Economy in Southern Nepal.The American journal of tropical medicine and hygiene · 2025Article
- A dose scaling antivenin protocol in treatment of Daboia palaestinae envenomation may reduce morbidity and costs.PloS one · 2025Article
- Article
- Antibody-dependent enhancement of toxicity of myotoxin II from Bothrops asper.Nature communications · 2024Article
- The Chinese guideline for management of snakebites.World journal of emergency medicine · 2024Article
- Virus-like particles displaying conserved toxin epitopes stimulate polyspecific, murine antibody responses capable of snake venom recognition.Scientific reports · 2022Article
- Clinical management of snakebite envenoming: Future perspectives.Toxicon: X · 2021Article
- Challenges in the Management of an Echis coloratus Adult Snakebite Victim at a Tertiary Care Hospital: A Case Report.The American journal of case reports · 2021Article
- Analysis of snakebite data in Volta and Oti Regions, Ghana, 2019.The Pan African medical journal · 2021Article
- A Bayesian phase 2 model based adaptive design to optimise antivenom dosing: Application to a dose-finding trial for a novel Russell's viper antivenom in Myanmar.PLoS neglected tropical diseases · 2020Article
- New insights into snakebite epidemiology in Costa Rica: A retrospective evaluation of medical records.Toxicon: X · 2020Article
- Cost of Manufacturing for Recombinant Snakebite Antivenoms.Frontiers in bioengineering and biotechnology · 2020Article
- The timing is right to end snakebite deaths in South Asia.BMJ (Clinical research ed.) · 2019Article
- Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom.Journal of tropical medicine · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCurrently, there is inadequate evidence on which to base clinical management of neurotoxic snakebite envenoming, especially in the choice of initial antivenom dosage. This randomised controlled trial compared the effectiveness and safety of high versus low initial antivenom dosage in victims of neurotoxic envenoming. METHODOLOGY/ PRINCIPAL
findingsThis was a balanced, randomised, double-blind trial that was conducted in three health care centers located in the Terai plains of Nepal. Participants received either low (two vials) or high (10 vials) initial dosage of Indian polyvalent antivenom. The primary composite outcome consisted of death, the need for assisted ventilation and worsening/recurrence of neurotoxicity. Hourly evaluations followed antivenom treatment. Between April 2011 and October 2012, 157 snakebite victims were enrolled, of which 154 were analysed (76 in the low and 78 in the high initial dose group). Sixty-seven (43·5%) participants met the primary outcome definition. The proportions were similar in the low (37 or 48.7%) vs. high (30 or 38.5%) initial dose group (difference = 10·2%, 95%CI [-6·7 to 27·1], p = 0·264). The mean number of vials used was similar between treatment groups. Overall, patients bitten by kraits did worse than those bitten by cobras. The occurrence of treatment-related adverse events did not differ among treatment groups. A total of 19 serious adverse events occurred, including seven attributed to antivenom.
conclusionsThis first robust trial investigating antivenom dosage for neurotoxic snakebite envenoming shows that the antivenom currently used in Nepal performs poorly. Although the high initial dose regimen is not more effective than the low initial dose, it offers the practical advantage of being a single dose, while not incurring higher consumption or enhanced risk of adverse reaction. The development of new and more effective antivenoms that better target the species responsible for bites in the region will help improve future patients' outcomes.
trial registrationThe study was registered on clinicaltrials.gov (NCT01284855) (GJ 5/1).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.