Immunotherapy of sepsis syndrome: a comparison of the available treatments.
OBJECTIVE
To evaluate the current range of immunotherapy for sepsis syndrome.


METHODS
Three major, recent anti-endotoxin and two human polyclonal, immunoglobulin clinical trials are reviewed. COMPARISONS: Comparisons are made in their trial design, definitions, patient selection and exclusion criteria and patient demographics. The results in specific subsets are compared and reasons for the differences in efficacy, discussed.


RESULTS
J5 anti-sera, E-5, and HA-1A are all effective in reducing the mortality in patients with gram-negative infections. They also result in enhanced resolution of organ failure. Similarities in the efficacies of J5 anti-sera and HA-1A for bacteremic patients with and without shock are noted. High-dose polyclonal human immunoglobulins have been shown to be of benefit in both gram-positive and gram-negative infections in two small clinical trials and deserve further evaluation.


CONCLUSIONS
Anti-endotoxin monoclonal antibodies benefit patients with gram-negative sepsis. They are proof of a concept, but are costly and do not show an overall intention-to-treat effect. There is an urgent need to accurately identify, clinically or by a cytokine profile, those patients who will specifically benefit.
Fisher
C J
CJ
Case Western Reserve University, University Hospitals of Cleveland.
Bellingan
G
G
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology; D003422:Critical Care; D022361:Escherichia coli Vaccines; D006801:Humans; D007106:Immune Sera / Q000008:administration & dosage / Q000276:immunology; D007167:Immunotherapy / Q000379:methods*; D012772:Shock, Septic / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D001428:Bacterial Vaccines; D022361:Escherichia coli Vaccines; D007106:Immune Sera