A Bayesian network meta-analysis on the effect of inodilatory agents on mortality.
Greco T1, Calabrò MG1, Covello RD1, Greco M1, Pasin L1, Morelli A2, Landoni G3, Zangrillo A1.
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April 13 will be interesting!
Abstract
BACKGROUND:
Inodilators are commonly used in critically ill patients, but their effect on survival has not been properly studied to date. The objective of this work was to conduct a network meta-analysis on the effects of inodilators on survival in adult cardiac surgery patients, and to compare and rank drugs that have not been adequately compared in head-to-head trials.
METHODS:
Relevant studies were independently searched in BioMedCentral, MEDLINE/PubMed, Embase, and the Cochrane Central Register of clinical trials (updated on May 1, 2014). The criteria for inclusion were: random allocation to treatment with at least one group receiving dobutamine, enoximone, levosimendan, or milrinone and at least another group receiving the above inodilators or placebo, performed in cardiac surgical patients. The endpoint was to identify differences in mortality at longest follow-up available.
RESULTS:
The 46 included trials were published between 1995 and 2014 and randomised 2647 patients. The Bayesian network meta-analysis found that only the use of levosimendan was associated with a decrease in mortality when compared with placebo (posterior mean of OR=0.48, 95% CrI 0.28 to 0.80). The posterior distribution of the probability for each inodilator to be the best and the worst drug showed that levosimendan is the best agent to improve survival after cardiac surgery. The sensitivity analyses performed did not produce different interpretative result.
CONCLUSION:
Levosimendan seems to be the most efficacious inodilator to improve survival in cardiac surgery.
and there is the potential of (see below)...why would TENX have paid $500'000 to get access to the trial data in the UK ?!
Sepsis is a life-threatening condition that causes the blood pressure to fall dangerously, compromising blood flow to vital organs such as the liver and kidney. It is the leading cause for admission to an intensive care unit in the UK, accounting for about 30% of all admissions. Despite advances in treatment around 40% of such patients unfortunately die.
Conventionally, adrenaline-like drugs are used to support a patient’s blood pressure but they can have serious side effects. Levosimendan is a new type of drug that is currently used to treat patients with advanced heart failure. It works in a different manner to adrenaline-like drugs, potentially avoiding some of these side effects. It may also improve the blood flow to vital organs. In small scale clinical trials in patients with sepsis who have been given levosimendan significant improvements were seen in the function of the heart, kidneys and other organs.
Septic shock is a medical condition as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site.[1] It can cause multiple organ dysfunction syndrome (formerly known as multiple organ failure) and death.[1] Its most common victims are children, immunocompromised individuals, and the elderly, as their immune systems cannot deal with the infection as effectively as those of healthy adults. Frequently, patients suffering from septic shock are cared for in intensive care units. The mortality rate from septic shock is approximately 25–50%.[1]
