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Critical Care
Published in: Critical Care 5/2006

01-10-2006 | Letter

Drotrecogin alfa (activated): down and not out, but not really in either

Authors: Jan O Friedrich, Neill KJ Adhikari, Maureen O Meade

Published in: Critical Care | Issue 5/2006

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Excerpt

We read with interest the letter by Agarwal and Nath [1] in response to our commentary [2] analyzing current evidence for drotrecogin alfa (activated) (DrotAA) in the treatment of severe sepsis. Agarwal and Nath argue that our meta-analysis should have used a fixed-effects model, which ignores between-study heterogeneity, rather than a more conservative random-effects model, which includes it. Such a model shows significant benefit for DrotAA in patients with severe sepsis and at a high risk of death defined either by an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 25 or more, or at least two organ dysfunctions. …
Literature
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2.
Friedrich JO, Adhikari NK, Meade MO: Drotrecogin alfa (activated): does current evidence support treatment for any patients with severe sepsis? Crit Care 2006, 10: 145. 10.1186/cc4947PubMedCentralCrossRefPubMed
3.
Abraham E, Laterre PF, Garg R, Levy H, Talwar D, Trzaskoma BL, Francois B, Guy JS, Bruckmann M, Rea-Neto A, for the Administration of Drotrecogin Alfa (Activated) in Early Stage Severe Sepsis (ADDRESS) Study Group, et al.: Drotrecogin alfa (activated) for adults with severe sepsis and a low risk of death. N Engl J Med 2005, 353: 1332-1341. 10.1056/NEJMoa050935CrossRefPubMed
4.
Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand D, Ely EW, for the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group, et al.: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001, 344: 699-709. 10.1056/NEJM200103083441001CrossRefPubMed
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Ely EW, Laterre PF, Angus DC, Bernard GR: Drotrecogin alfa (activated) administration: too many subgroups [Letter]. Crit Care Med 2003, 31: 2564-2565. 10.1097/00003246-200301000-00002CrossRef
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Ely EW, Laterre PF, Angus DC, Helterbrand JD, Levy H, Dhainaut JF, Vincent JL, Macias WL, Bernard GR, PROWESS Investigators: Drotrecogin alfa (activated) administration across clinically important subgroups of patients with severe sepsis. Crit Care Med 2003, 31: 12-19. 10.1097/00003246-200301000-00002CrossRefPubMed
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Schultz MJ, Levi M: Prescription of rh-APC differssubstantially among western European countries. Intensive Care Med 2006, 32: 630-631. 10.1007/s00134-006-0075-zCrossRefPubMed
Metadata
Title
Drotrecogin alfa (activated): down and not out, but not really in either
Authors
Jan O Friedrich
Neill KJ Adhikari
Maureen O Meade
Publication date
01-10-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5022

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