Immunomodulatory drugs in sepsis: a systematic review and meta‐analysis
Authors' conclusion
These data indicate that, except for toll-like receptor 4 antagonists, there is no evidence of safety concerns for the use of immunomodulatory drugs in sepsis, and they may show some short-term mortality benefit for selected drugs.
Study context
- Population
- Adults with sepsis56 RCTs
- Comparison
- Immunomodulatory drugs as adjuncts to standard care vs standard care
- Outcome
- Serious adverse events and all-cause mortality
Pooled result
As reported in the abstract
Each group vs standard careRelative risk (95% CI)
Cytokine inhibitorsserious adverse events, 1 month; 11 studies, 7138 patients; I2 = 0%
0.95(0.90–1.00)
Toll-like receptor 4 antagonistsserious adverse events; two trials, 567 patients; I2 = 0%
1.18(1.04–1.34)
Cytokine inhibitors1-month mortality; 18 RCTs, 11,075 patients; I2 = 57%
0.88(0.78–0.98)
Further pooled results
1-month mortality, anti-tumour necrosis factor α subgroup (subgroup)
| RR (95% CI) | ||
|---|---|---|
| Anti-tumour necrosis factor α interventions13 RCTs; I2 = 0% | 0.93 (0.87–0.99) | |
| 0.512Relative risk (log scale) |
Mortality, anti-inflammatory drugs at any dose · 2 months
| RR (95% CI) | ||
|---|---|---|
| Anti-inflammatory drugs2 trials, 228 patients; I2 = 0% | 0.64 (0.51–0.80) | |
| 0.512Relative risk (log scale) |
Mortality, anti-inflammatory drugs at any dose · 3 months
| RR (95% CI) | ||
|---|---|---|
| Anti-inflammatory drugs3 trials, 277 patients; I2 = 0% | 0.67 (0.55–0.81) | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Serious adverse events · 1 monthToll-like receptor 4 antagonists vs Standard care · two trials, 567 patients; I2 = 0% | 1.18 (1.04–1.34) | |
| Serious adverse events · 1 monthCytokine inhibitors vs Standard care · 11 studies, 7138 patients; I2 = 0% | 0.95 (0.90–1.00) | |
| 0.512Relative risk (log scale) |
Original publication
Immunomodulatory drugs in sepsis: a systematic review and meta‐analysis. Anaesthesia. Published 24 March 2024. doi:10.
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