I’ve said this on numerous occasions and I’ll repeat it again. I do not do research. I have one study published and that’s because I needed to do it to complete fellowship. Outside of that, I’m a boot on the ground doc. I feel bad criticizing but here we are regarding angiotensin II/Giapreza. Now that that’s out of the way, I can’t believe that so many huge names in critical care research are listed on this study that has sooooo many issues.
I’m always excited at the prospects of a new vasopressor or anything to help out my patients in shock, but at $1500 a vial, we better be seeing some serious benefits.
Angiotensin II/Giapreza in Shock: Findings
Here’s my take and I’m over simplifying: they took real shock patients who were on norepinephrine and gave them either the study drug, known since the 1930’s to cause an increase in BP, or a placebo. Basically giving a hungry person food or air and seeing which one made them feel full. Obviously the delicious meal group felt full. Oddly enough, 23.4% of the pts who received placebo had an increase in their BP. And then people try to tell me this is good data? Want to have some air?
There was also a change in their CV SOFA score. I had to look this up but it means the patients had a decrease in pressor requirement. Well, isn’t that the point? How about having the patient on NE and adding Vasopressin in one group and adding Giapreza in the next? Wouldn’t that world out better? Oh, yeah, this study was sponsored by La Jolla. They created softball endpoints. That’s lame.
Ultimately, you should check out @pulmcrit (Josh Farkas) post on this from two years ago. It’s much better than mine: https://emcrit.org/pulmcrit/angiotensin-ii/
Also, I am working on a comprehensive vasopressor post HERE. – EJ
Citations on Giapreza/Angiotensin II
Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, Busse LW, Altaweel L, Albertson TE, Mackey C, McCurdy MT, Boldt DW, Chock S, Young PJ, Krell K, Wunderink RG, Ostermann M, Murugan R, Gong MN, Panwar R, Hästbacka J, Favory R, Venkatesh B, Thompson BT, Bellomo R, Jensen J, Kroll S, Chawla LS, Tidmarsh GF, Deane AM; ATHOS-3 Investigators. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med. 2017 Aug 3;377(5):419-430. doi: 10.1056/NEJMoa1704154. Epub 2017 May 21. PMID: 28528561.
Link to Article
Link to FULL FREE PDF
Disclaimer
Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
How to support my work:
my efforts are at no cost to you and I would like to keep it that way. You have to look at ads on this website, listen to them on my podcast and YouTube content. Thanks for bearing with me. But if you want to help out a little more, also at no cost to you, consider a free trial with Audible where you will get a free book (and two books if you are an Amazon Prime member. If you CLICK HERE and sign up for Audible, they will provide me with a commission in exchange for you joining. They will remind you to potentially discontinue your membership so you don’t get charged. Thanks for your support!
