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Title: High-dose immunosuppression to prevent death after paraquat self-poisoning–a randomised controlled trial
Authors: Indika Gawarammana
Nicholas A. Buckley
Fahim Mohamed
Kamal Naser
K. Jeganathan
P. L. Ariyananada
Klintean Wunnapuk
Timothy A. Dobbins
John A. Tomenson
Martin F. Wilks
Michael Eddleston
Andrew H. Dawson
Keywords: Pharmacology, Toxicology and Pharmaceutics
Issue Date: 3-Jul-2018
Abstract: © 2017 Informa UK Limited, trading as Taylor & Francis Group. Context: Intentional self-poisoning with the herbicide paraquat has a very high case-fatality and is a major problem in rural Asia and Pacific. Objectives: We aimed to determine whether the addition of immunosuppression to supportive care offers benefit in resource poor Asian district hospitals. 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. 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. 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.
ISSN: 15569519
Appears in Collections:CMUL: Journal Articles

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