Assessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study.
OBJECTIVE
To investigate the safety, biological effects, and efficacy of the anti-tumor necrosis factor (TNF) antibody fragment, MAK 195F, in a phase II trial in patient with severe sepsis.


METHODS
Prospective, randomized, open label, placebo-controlled, dose-ranging, multicenter, multinational clinical trial.


METHODS
Sixteen academic medical centers' intensive care units in six European countries.


METHODS
One hundred twenty-two patients with severe sepsis or septic shock who received standard supportive care and antimicrobial therapy.


METHODS
Patients received one of three different doses of the anti-TNF antibody (0.1 mg/kg, 0.3 mg/kg, or 1.0 mg/kg) or placebo; the antibody or placebo was given in nine doses at 8-hr intervals over 3 days.


RESULTS
There were no significant differences in mortality rates among the groups receiving various doses of the anti-TNF antibody or placebo, but patients with baseline serum interleukin (IL)-6 concentrations of > 1000 pg/mL appeared to benefit from MAK 195F in a dose-dependent fashion. Increased circulating IL-6 concentrations, but not TNF concentrations, were found to be important prognostic indicators for mortality for the patients in the placebo and the two lower dosage groups but not in the high dosage group (1 mg/kg). IL-6 concentrations decreased during the first 24 hrs of treatment in all three anti-TNF groups but not in the placebo group. MAK 195F was well tolerated by all patients. Human antimurine antibodies developed in 40% of the patients receiving the antibody.


CONCLUSIONS
There was no increase in survival from sepsis for the patients receiving anti-TNF treatment in the overall study population. Retrospective stratification of patients by IL-6 concentrations suggests beneficial effects of the drug for patients with baseline circulating IL-6 concentrations of > 1000 pg/mL. This hypothesis requires validation in a larger, blinded, prospective study.
Reinhart
K
K
Klinik Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universitat, Jena, Germany.
Wiegand-Löhnert
C
C
Grimminger
F
F
Kaul
M
M
Withington
S
S
Treacher
D
D
Eckart
J
J
Willatts
S
S
Bouza
C
C
Krausch
D
D
Stockenhuber
F
F
Eiselstein
J
J
Daum
L
L
Kempeni
J
J
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha