TY  - JOUR
PY  - 2018//
TI  - High-dose immunosuppression to prevent death after paraquat self-poisoning - a randomised controlled trial
JO  - Clinical toxicology (Philadelphia, Pa.)
A1  - Gawarammana, Indika
A1  - Buckley, Nicholas A.
A1  - Mohamed, Fahim
A1  - Naser, Kamal
A1  - Jeganathan, K.
A1  - Ariyananada, P. L.
A1  - Wunnapuk, Klintean
A1  - Dobbins, Timothy A.
A1  - Tomenson, John A.
A1  - Wilks, Martin F.
A1  - Eddleston, Michael
A1  - Dawson, Andrew H.
SP  - 633
EP  - 639
VL  - 56
IS  - 7
N2  - CONTEXT: Intentional self-poisoning with the herbicide paraquat has a very high case-fatality and is a major problem in rural Asia and Pacific. <br><br>OBJECTIVES: We aimed to determine whether the addition of immunosuppression to supportive care offers benefit in resource poor Asian district hospitals. <br><br>MATERIALS AND METHODS: We performed a randomised placebo-controlled trial comparing immunosuppression (intravenous cyclophosphamide up to 1 g/day for two days and methylprednisolone 1 g/day for three days, and then oral dexamethasone 8 mg three-times-a-day for 14 days) with saline and placebo tablets, in addition to standard care, in patients with acute paraquat self-poisoning admitted to six Sri Lankan hospitals between 1st March 2007 and 15th November 2010. The primary outcome was in-hospital mortality. <br><br>RESULTS: 299 patients were randomised to receive immunosuppression (147) or saline/placebo (152). There was no significant difference in in-hospital mortality rates between the groups (immunosuppression 78 [53%] vs. placebo 94 [62%] (Chi squared test 2.4, p = .12). There was no difference in mortality at three months between the immunosuppression (101/147 [69%]) and placebo groups (108/152 [71%]); (mortality reduction 2%, 95% CI: -8 to +12%). A Cox model did not support benefit from high-dose immunosuppression but suggested potential benefit from the subsequent two weeks of dexamethasone. <br><br>CONCLUSIONS: We found no evidence that high dose immunosuppression improves survival in paraquat-poisoned patients. The continuing high mortality means further research on the use of dexamethasone and other potential treatments is urgently needed.<p />  <p>Language: en</p>
LA  - en
SN  - 1556-3650
UR  - http://dx.doi.org/10.1080/15563650.2017.1394465
ID  - ref1
ER  -