Treatment of Septic Shock With the Tumor Necrosis Factor receptor:Fc Fusion Protein. The Soluble TNF Receptor Sepsis Study Group

N Engl J Med. 1996 Jun 27;334(26):1697-702. doi: 10.1056/NEJM199606273342603.

Abstract

Background: A recombinant, soluble fusion protein that is a dimer of an extracellular portion of the human tumor necrosis factor (TNF) receptor and the Fc portion of IgG1 (TNFR:Fc) binds and neutralizes TNF-alpha and prevents death in animal models of bacteremia and endotoxemia.

Methods: To evaluate the safety and efficacy of TNFR:Fc in the treatment of septic shock, we conducted a randomized, double-blind, placebo-controlled, multicenter trial. A total of 141 patients were randomly assigned to receive either placebo or a single intravenous infusion of one of three doses of TNFR:Fc (0.15, 0.45, or 1.5 mg per kilogram of body weight). The primary end point was mortality from all causes at 28 days.

Results: There were 10 deaths among the 33 patients in the placebo group (30 percent mortality), 9 deaths among the 30 patients receiving the low dose of TNFR:Fc (30 percent mortality), 14 deaths among the 29 receiving the middle dose (48 percent mortality), and 26 deaths among the 49 receiving the high dose (53 percent mortality) (P = 0.02 for the dose-response relation). Baseline differences in the severity of illness did not account for the increased mortality in the groups receiving the higher doses of TNFR:Fc.

Conclusions: In patients with septic shock, treatment with the TNFR:Fc fusion protein does not reduce mortality, and higher doses appear to be associated with increased mortality.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • APACHE
  • Cytokines / blood
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Endotoxins / blood
  • Female
  • Humans
  • Immunoglobulin Fc Fragments / therapeutic use*
  • Immunoglobulin G / therapeutic use
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Receptors, Tumor Necrosis Factor*
  • Recombinant Fusion Proteins / therapeutic use*
  • Shock, Septic / immunology
  • Shock, Septic / mortality
  • Shock, Septic / therapy*
  • Survival Analysis
  • Treatment Outcome

Substances

  • Cytokines
  • Endotoxins
  • Immunoglobulin Fc Fragments
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Recombinant Fusion Proteins