Saturday, January 4, 2020

Angiotensin II/ Giapreza

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. 
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. 
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. So you mean to tell me that a $6 dose of vitamin c is garbage but have no qualms with this study? Get out of here. 

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/

- EJ

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