Trial reportBMJ global health2024
Oral varespladib for the treatment of snakebite envenoming in India and the USA (BRAVO): a phase II randomised clinical trial.
Trial report in BMJ global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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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.
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Who cites it
18 citing papers in PubMed.
- Adjunctive Varespladib after antivenom administration for snakebite: A phase II randomized clinical trial.PLoS neglected tropical diseases · 2026Trial
- Article
- Exploiting the Property of a New Series of 1,2,3-Triazole Compounds as Inhibitors of In Vivo and In Vitro Toxic Effects Caused byTropical medicine and infectious disease · 2026Article
- Article
- Targeting Key Enzymatic Snake Venom Proteins Using Repurposed Small Molecule Inhibitors: Emerging Adjuncts to Antivenom Therapy.International journal of molecular sciences · 2026Review
- Endogenous "Time Bomb" - Mislocalized Phospholipase A2 as a Critical Mediator of Ultra-Rapid Mortality in Sepsis and Acute Lung Injury.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Venom variation and the future of antivenom design: Integrating population venomics, evolutionary toxinology, and precision therapeutics.Toxicon: X · 2026Review
- Identification of DC-174 as a Novel Hydroxamic Precandidate for the Development of an Oral Snakebite Treatment.Journal of medicinal chemistry · 2026Article
- Chinese cobra (Naja atra) SVPLACommunications biology · 2026Article
- Article
- Snake envenomation in veterinary medicine: comparative insights and emerging therapies.Frontiers in veterinary science · 2026Review
- Proteomic profiling and comparative hemotoxicity ofThe journal of venomous animals and toxins including tropical diseases · 2026Article
- Large animal models for the assessment of snakebite envenoming therapies.npj drug discovery · 2026Review
- Long-Term Clinical Outcomes of Rattlesnake Envenomation in Arizona Following Treatment With Crofab vs Anavip: A Retrospective Observational Study.Journal of the American College of Emergency Physicians open · 2025Article
- Snake envenomation in Florida: a 20-year analysis of epidemiology and clinical outcomes at a tertiary medical centre.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2025Article
- Review
- Article
- Article
Corrections and comments
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Authors and funding
29 authors.
Funding
Abstract
introductionSnakebite envenoming (SBE) results in over 500 000 deaths or disabling injuries annually. Varespladib methyl, an oral inhibitor of secretory phospholipase A2, is a nearly ubiquitous component of snake venoms. We conducted a phase II clinical trial to assess efficacy and safety of oral varespladib methyl in patients bitten by venomous snakes.
methodsThis double-blind, randomised, placebo-controlled trial enrolled patients in emergency departments in India and the USA. Patients with SBE were randomly assigned (1:1) to receive varespladib methyl or placebo two times per day for 1 week. All patients received standard of care, including antivenom. The primary outcome was change in the composite Snakebite Severity Score (SSS) measuring the severity of envenoming, from baseline to the average composite SSS at 6 and 9 hours.
resultsAmong 95 patients randomised August 2021 through November 2022, the most common snakebites were from Russell's vipers (n=29), copperheads (n=18) and rattlesnakes (n=14). The SSS improved from baseline to the average at 6 and 9 hours by 1.1 (95% CI, 0.7 to 1.6) in the varespladib group versus 1.5 (95% CI, 1.0 to 2.0) in the placebo group (difference -0.4, 95% CI, -0.8 to 0.1, p=0.13). While key secondary outcomes were not statistically different by treatment group, benefit was seen in the prespecified subgroup initiating study drug within 5 hours of bite (n=37). For this early treatment group, clinically important differences were observed for illness severity over the first week, patient-reported function on days 3 and 7 and complete recovery. No death or treatment emergent serious adverse event occurred.
conclusionFor emergency department treatment of snakebites, the addition of varespladib to antivenom did not find evidence of difference for the primary outcome based on the SSS. A potentially promising signal of benefit was observed in patients initiating treatment within 5 hours of snakebite.
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