Drotrecogin alfa: start early, ensure response, stop early!

Introduction

Drotrecogin alfa (DA) is an effective treatment in sepsis-induced MODS. Optimum duration of treatment is 96 hours of infusion. It is unclear whether stopping DA before 96 hours, in patients in whom organ dysfunction rapidly resolves, ultimately affects the 30-day mortality. We performed a prospective study to evaluate this concept.

Methods

We evaluated patients with severe sepsis having three or more organ failures (OF) who received DA within 24 hours of onset. We stopped DA before completion of 96 hours of infusion, assuring complete resolution of OF. All of these patients were monitored for reappearance of OF until discharge from hospital.

Results

Six patients with APACHE II score 25 ± 1.89 were evaluated. All six patients recovered completely from MODS and were discharged to home. Reappearance of OF was not seen in any of them. See Table 1.

Table 1 Patient data

Conclusion

DA can be safely stopped before 96 hours in patients who show rapid reversal of organ dysfunction.