…or it might not. This is a tiny study using a very expensive medication that probably works only on a few patients, but it’s interesting nonetheless.
As part of the inflammatory cascade, C1-esterase inhibitor (C1INH) modulates the coagulation cascade, impacts leukocyte activation, enhances bactericidal activity, and prevents endotoxin shock in sepsis models. So, sounds like a good thing – let’s give it to patients and see what happens!
This was an open-label, randomized, controlled study in Moscow and St. Petersburg with 62 ICU patients – 20 controls and 42 treatment patients – that met inclusion criteria. There were, unfortunately, a lot of differences between the control group and the treatment group. These differences included a lot more post-operative patients, much more pneumonia, and more on the ventilator, and probably favored the treatment group. The mortality is way better for the treatment group – 12% dead versus 45% – but it’s simply impossible to attribute all the effects to C1INH with all the other confounding differences.
That being said, this study is consistent the effects from other small studies. Therefore, we will likely hear more about C1INH after larger, manufacturer-sponsored trials also undoubtedly find a way to spin positive results.
“C1-esterase inhibitor infusion increases survival rates for patients with sepsis”
www.ncbi.nlm.nih.gov/pubmed/22080632