Randomized, placebo-controlled trial of the anti-tumor necrosis factor antibody fragment afelimomab in hyperinflammatory response during severe sepsis: The RAMSES study

Konrad Reinhart, Thilo Menges, Bengt Gardlund, Jan Harm Zwaveling, Mark Smithes, Jean Louis Vincent, Jose Maria Tellado, Antonio Salgado-Remigio, Reuven Zimlichman, Stuart Withington, Klaus Tschaikowsky, Rainer Brase, Pierre Damas, Hartmut Kupper, Joachim Kempeni, Juergen Eiselstein, Martin Kaul

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: This study investigated whether treatment with the anti-tumor necrosis factor-α monoclonal antibody afelimomab would improve survival in septic patients with serum interleukin (IL)-6 concentrations of >1000 pg/mL. Design: Multicenter, double-blind, randomized, placebo-controlled study. Setting: Eighty-four intensive care units in academic medical centers in Europe and Israel. Patients: A total of 944 septic patients were screened and stratified by the results of a rapid qualitative immunostrip test for serum IL-6 concentrations. Patients with a positive test kit result indicating IL-6 concentrations of >1000 pg/mL were randomized to receive either afelimomab (n = 224) or placebo (n = 222). Patients with a negative IL-6 test (n = 498) were not randomized and were followed up for 28 days. Interventions: Treatment consisted of 15-min infusions of 1 mg/kg afelimomab or matching placebo every 8 hrs for 3 days. Standard surgical and intensive care therapy was otherwise delivered. Measurements and Main Results: The study was terminated prematurely after an interim analysis estimated that the primary efficacy end points would not be met. The 28-day mortality rate in the nonrandomized patients (39.6%, 197 of 498) was significantly lower (p < .001) than that found in the randomized patients (55.8%, 249 of 446). The mortality rates in the IL-6 test kit positive patients randomized to afelimomab and placebo were similar, 54.0% (121 of 224) vs. 57.7% (128 of 222), respectively. Treatment with afelimomab was not associated with any particular adverse events. Conclusions: The IL-6 immunostrip test identified two distinct sepsis populations with significantly different mortality rates. A small (3.7%) absolute reduction in mortality rate was found in the afelimomab-treated patients. The treatment difference did not reach statistical significance.

Original languageEnglish
Pages (from-to)765-769
Number of pages5
JournalCritical Care Medicine
Volume29
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Clinical trial
  • Critical illness
  • Cytokines
  • Infection
  • Interleukin-6
  • Monoclonal antibody
  • Sepsi
  • Septic shock
  • Tumor necrosis factor

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