High-dose immunosuppression to prevent death after paraquat self-poisoning - a randomised controlled trial

Gawarammana, Indika and Buckley, Nicholas A. and Mohamed, Fahim and Naser, Kamal and Jeganathan, K. and Ariyananada, P. L. and Wunnapuk, Klintean and Dobbins, Timothy A. and Tomenson, John A. and Wilks, Martin F. and Eddleston, Michael and Dawson, Andrew H.. (2018) High-dose immunosuppression to prevent death after paraquat self-poisoning - a randomised controlled trial. Clinical toxicology, 56 (7). pp. 633-639.

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Official URL: https://edoc.unibas.ch/78574/

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Intentional self-poisoning with the herbicide paraquat has a very high case-fatality and is a major problem in rural Asia and Pacific.; We aimed to determine whether the addition of immunosuppression to supportive care offers benefit in resource poor Asian district hospitals.; 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.; 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.; 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.
Faculties and Departments:05 Faculty of Science > Departement Pharmazeutische Wissenschaften > Pharmazie > Regulatory Toxicology (Wilks)
UniBasel Contributors:Wilks, Martin F.
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Taylor and Francis
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:05 Oct 2020 06:49
Deposited On:05 Oct 2020 06:49

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