Digoxin immune fab treatment for severe preeclampsia.
We evaluated the efficacy, safety, and biological mechanisms of digoxin immune Fab (DIF) treatment of severe preeclampsia. Fifty-one severe preeclamptic patients were randomized in double-blind fashion to DIF ( N = 24) or placebo ( N = 27) for 48 hours. Primary outcomes were change in creatinine clearance (CrCl) at 24 to 48 hours and antihypertensive drug use. Serum sodium pump inhibition, a sequela of endogenous digitalis-like factors (EDLF), was also assessed. CrCl in DIF subjects was essentially unchanged from baseline versus a decrease with placebo (-3 +/- 10 and -34 +/- 10 mL/min, respectively, P = 0.02). Antihypertensive use was similar between treatments (46 and 52%, respectively, P = 0.7). Serum sodium pump inhibition was decreased with DIF compared with placebo at 24 hours after treatment initiation (least squares mean difference, 19 percentage points, P = 0.03). DIF appeared to be well tolerated. These results suggest DIF prevents a decline in renal function in severe preeclampsia by neutralizing EDLF. Sodium pump inhibition was significantly improved. Further research is warranted.
Adair
C David
CD
University of Tennessee, Chattanooga, TN 37402, USA. David.Adair@Glenveigh.com
Buckalew
Vardaman M
VM
Graves
Steven W
SW
Lam
Garrett K
GK
Johnson
Donna D
DD
Saade
George
G
Lewis
David F
DF
Robinson
Christopher
C
Danoff
Theodore M
TM
Chauhan
Nikhil
N
Hopoate-Sitake
Moana
M
Porter
Kathy B
KB
Humphrey
Rachel G
RG
Trofatter
Kenneth F
KF
Amon
Erol
E
Ward
Suzanne
S
Kennedy
Lizbeth
L
Mason
Lorrie
L
Johnston
J Andrew
JA
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002298:Cardenolides / Q000097:blood; D004077:Digoxin / Q000276:immunology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000032:analysis; D007677:Kidney Function Tests; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012503:Saponins / Q000097:blood; D000254:Sodium-Potassium-Exchanging ATPase / Q000037:antagonists & inhibitors; D016896:Treatment Outcome; D055815:Young Adult
D000959:Antihypertensive Agents; D002298:Cardenolides; D007140:Immunoglobulin Fab Fragments; D012503:Saponins; C050199:digoxin antibodies Fab fragments; C034504:digoxin-like factors; D004077:Digoxin; D000254:Sodium-Potassium-Exchanging ATPase