Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010

Cui, Xizhong; Nolen, Leisha D.; Sun, Junfeng; Booth, Malcolm; Donaldson, Lindsay; Quinn, Conrad P.; Boyer, Anne; Hendricks, Katherine; Shadomy, Sean V.; Bothma, Pieter; Judd,; McConnell, Paul; Bower, William A.; Eichacker, Peter Q.

doi:10.3201/eid2301.160608

Cited by 21 publications

(17 citation statements)

References 24 publications

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“…anthracis soft-tissue infection during the 2009 to 2010 outbreak in Scotland related to the use of contaminated heroin. [ 9 ] Notably, review of 43 patients from that outbreak including all AIG recipients, showed that mortality in this uncontrolled experience did not differ comparing recipients and non-recipients. However, comparisons between these recipients and non-recipients are difficult to make.…”

Section: Introductionmentioning

confidence: 90%

A systematic review and meta-analysis of preclinical trials testing anti-toxin therapies for B. anthracis infection: A need for more robust study designs and results

Ohanjanian

Sun

et al. 2017

PLoS ONE

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BackgroundB. anthracis anti-toxin agents are approved and included in the Strategic National Stockpile based primarily on animal infection trials. However, in the only anthrax outbreak an approved anti-toxin agent was administered in, survival did not differ comparing recipients and non-recipients, although recipients appeared sicker.ObjectiveEmploy a systematic review and meta-analysis to investigate preclinical studies supporting anthrax anti-toxin agents.Data sourcePubMed, EMBASE, and Scopus.Study eligibilityCompared survival with an anti-toxin agent versus control in B. anthracis challenged, antibiotic treated animals.Study methodsExamine model and study design and the effect of anti-toxin agents on relative risk of death(95%CI) (RR).ResultsFrom 9 studies, 29 experiments were analyzed which included 4 species (748 animals) and 5 agents; LFI, AIG, AVP-21D9, Raxibacumab, and ETI-204. Only five experiments were blinded and no experiment included the cardiopulmonary support sick B. anthracis patients receive. Only one agent in a single un-blinded experiment reduced RR significantly [0.45(0.22,0.940]. However, in six studies testing an agent in more than one experiment in the same species, agents had consistent survival effects across experiments [I2 = 0, p≥0.55 in five and I2 = 42%, p = 0.16 in one]. Within each species, agents had effects on the side of benefit; in one study testing AVP-21D9 in mice [0.11(0.01,1.82)] or guinea pigs [0.70(0.48,1.03)]; across eight rabbit studies testing LFI, Raxibacumab, AIG or ETI-204 [0.62(0.45,0.87); I2 = 17.4%, p = 0.29]; and across three monkey studies testing Raxibacumab, AIG or ETI-204 [0.66(0.34,1.27); I2 = 25.3%, p = 0.26]. Across all agents and species, agents decreased RR [0.64(0.52,0.79); I2 = 5.3%, p = 0.39].LimitationsIncidence of selective reporting not identifiable.ConclusionsAlthough overall significant, individually anti-toxin agents had weak beneficial effects. Lack of study blinding and relevant clinical therapies further weakened studies. Although difficult, preclinical studies with more robust designs and results are warranted to justify the resources necessary to maintain anti-toxin agents in national stockpiles.

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Section: Introductionmentioning

confidence: 90%

A systematic review and meta-analysis of preclinical trials testing anti-toxin therapies for B. anthracis infection: A need for more robust study designs and results

Ohanjanian

Sun

et al. 2017

PLoS ONE

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“…However, a meta-analysis of 9 such studies did not show significant results. 16 It is well documented that a timely and appropriate antibiotic therapy leads to dramatic recovery. Bacillus anthracis from naturally occurring cases is invariably penicillin sensitive.…”

Section: Treatmentmentioning

confidence: 99%

Bioterrorism: Clinical and public health aspects of anthrax

Chugh¹

2019

Current Medicine Research and Practice

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a b s t r a c tBioterrorism is intentional use of bioweapons (bacteria, viruses, or fungi or their toxins) to harm people, animals, agriculture, or environment of a country. Its impact can cause high mortality and morbidity and serious disruption of economy and social and political life. Countries must be fully equipped to respond through adequate surveillance systems and management, containment, and preventive policies.

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“…The medical countermeasures against a bioterrorist occurrence or a natural emergence are frequently overlapping, as exemplified by the use of polyclonal serum during an outbreak of anthrax in drug users, or the Ebola vaccine in the outbreaks in Africa this decade. 8,9 Nationally and transnationally, interfacing and strengthening the research, development, and implementation of these counter-measures is clearly beneficial for global health and security. Building efficient communications is a big part of the challenge.…”

Section: The Threat Of Bioterrorismmentioning

confidence: 99%

The threat of bioterrorism

Tournier

Peyrefitte²,

Biot³

et al. 2019

The Lancet Infectious Diseases

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Analysis of Anthrax Immune Globulin Intravenous with Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010

Abstract: Differences between recipients and nonrecipients and the small number of higher risk patients confounded assessment.

Cited by 21 publications

References 24 publications

A systematic review and meta-analysis of preclinical trials testing anti-toxin therapies for B. anthracis infection: A need for more robust study designs and results

A systematic review and meta-analysis of preclinical trials testing anti-toxin therapies for B. anthracis infection: A need for more robust study designs and results

Bioterrorism: Clinical and public health aspects of anthrax

The threat of bioterrorism

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