Combination therapy with sivelestat and recombinant human soluble thrombomodulin for ARDS and DIC patients

Abstract

Background

Neutrophil elastase, alveolar thrombin generation, and fibrin deposition play crucial roles in the development of acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). However, the usefulness of combination therapy with a selective neutrophil elastase inhibitor, sivelestat, and recombinant human soluble thrombomodulin (rhTM) for patients with ARDS and DIC remains unknown.

Methods

We conducted a retrospective data analysis of 142 ARDS patients with DIC to assess the effects of sivelestat combined with rhTM. Patients were divided into four groups: control (no sivelestat or rhTM treatment), sivelestat treatment alone, rhTM treatment alone, and combined treatment with sivelestat and rhTM. A Cox proportional hazard model was used to assess subject mortality rates. The efficacy of these drugs was evaluated based on survival rate, number of ventilator-free days, and change in PaO₂/F_IO₂ (P/F) ratios and DIC scores before and at 7 days after a diagnosis of ARDS with DIC.

Results

Multivariate analysis showed that patient age, combination therapy, gas exchange, organ failure, cause, associated disease score, and serum C-reactive protein levels were predictors of mortality for patients with ARDS and DIC. As compared with untreated controls, combination therapy significantly improved the 60-day survival rate of patients with ARDS and DIC. There were significantly more ventilator-free days for those who received combination therapy than for untreated controls. P/F ratios and DIC scores were significantly improved with sivelestat alone, rhTM alone, or their combination as compared with untreated controls.

Conclusion

Our results suggest that combined treatment with sivelestat and rhTM has beneficial effects on survival and the respiratory and DIC status of patients with ARDS and DIC.

Keywords:

• sivelestat
• recombinant human soluble thrombomodulin
• disseminated intravascular coagulation
• acute respiratory distress syndrome

Disclosure

JH has received research grants from Takeda Pharm Ltd, Mochida Pharm Ltd, Novartis Pharm Ltd, Pfizer Ltd, MSD Ltd, Astellas Pharm Ltd, Japan Boehringer-Ingelheim Ltd, Daiichi-Sankyo Ltd, and Dainihon-Sumitomo Pharm Ltd, and has received honoraria from Takeda Pharm Ltd, Inter-Science Ltd, Mochida Pharm Ltd, Novartis Pharm Ltd, Pfizer Ltd, MSD Ltd, Astellas Pharm Ltd, Japan Boehringer-Ingelheim Ltd, Dainihon-Sumitomo Pharm Ltd, and Teijin Pharm Ltd. The other authors report no conflicts of interest in this work.