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Drotrecogin alfa (activated) ... a sad final fizzle to a roller-coaster party

Angus, DC (2012) Drotrecogin alfa (activated) ... a sad final fizzle to a roller-coaster party. Critical Care, 16 (1). ISSN 1364-8535

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Following the failure of PROWESS-SHOCK to demonstrate efficacy, Eli Lilly and Company withdrew drotrecogin alfa (activated) from the worldwide market. Drotrecogin was initially approved after the original trial, PROWESS, was stopped early for overwhelming efficacy. These events prompt consideration of both the initial approval decision and the later decision to withdraw. It is regrettable that the initial decision was made largely on a single trial that was stopped early. However, the decision to approve was within the bounds of normal regulatory practice and was made by many approval bodies around the world. Furthermore, the overall withdrawal rate of approved drugs remains very low. The decision to withdraw was a voluntary decision by Eli Lilly and Company and likely reflected key business considerations. Drotrecogin does have important biologic effects, and it is probable that we do not know how best to select patients who would benefit. Overall, there may still be a small advantage to drotrecogin alfa, even used non-selectively, but the costs of determining such an effect with adequate certainty are likely prohibitive, and the point is now moot. In the future, we should consider ways to make clinical trials easier and quicker so that more information can be available in a timely manner when considering regulatory approval. At the same time, more sophisticated selection of patients seems key if we are to most wisely test agents designed to manipulate the septic host response. © 2012 BioMed Central Ltd.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Date: 6 February 2012
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 16
Number: 1
DOI or Unique Handle: 10.1186/cc11152
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1364-8535
Date Deposited: 01 Nov 2016 18:28
Last Modified: 01 Jan 2020 14:55


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