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A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism - the RAVE study

Isbister, GK, Brown, SGA, Miller, M, Tankel, A, Macdonald, E, Stokes, B, Ellis, R, Nagree, Y, Wilkes, GJ, James, R, Short, A and Holdgate, A (2008). A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism - the RAVE study. QJM: an international journal of medicine,101(7):557-565.

Document type: Journal Article
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Title A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism - the RAVE study
Author Isbister, GK
Brown, SGA
Miller, M
Tankel, A
Macdonald, E
Stokes, B
Ellis, R
Nagree, Y
Wilkes, GJ
James, R
Short, A
Holdgate, A
Journal Name QJM: an international journal of medicine
Publication Date 2008
Volume Number 101
Issue Number 7
ISSN 1460-2393   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-46249120194
Start Page 557
End Page 565
Total Pages 9
Place of Publication UK
Publisher Oxford University Press
Field of Research 0601 - Biochemistry and Cell Biology
1102 - Cardiovascular Medicine and Haematology
HERDC Category C1 - Journal Article (DEST)
Abstract Background: Widow spider-bite causes latrodectism and is associated with significant morbidity worldwide. Antivenom is given by both the intravenous (IV) and intramuscular (IM) routes and it is unclear which is more effective. Aim: To compare the effectiveness of IV vs. IM redback spider antivenom. Design: Randomized controlled trial. Methods: Patients with latrodectism were given either IV or IM antivenom according to a randomized double-dummy, double-blind protocol. The first antivenom treatment was followed by another identical treatment after two hours if required. The primary outcome was a clinically significant reduction in pain two hours after the last treatment. A fully Bayesian analysis was used to estimate the probability of the desired treatment effect, predetermined as an absolute difference of 20%. Results: We randomly allocated 126 patients to receive antivenom IV (64) and IM (62). After antivenom treatment pain improved in 40/64(62%) in the IV group vs. 33/62(53%) in the IM group (+9%; 95% Credible Interval [CrI]: -8% to +26%). The probability of a difference greater than zero (IV superior) was 85% but the probability of a difference >20% was only 10%. In 55 patients with systemic effects, these improved in 58% after IV antivenom vs. 65% after IM antivenom (-8%; 95% CrI: -32% to +17%). Twenty-four hours after antivenom pain had improved in 84% in the IV group vs. 71% in the IM group (+13%; 95% CrI: -2% to +27%). A meta-analysis including data from a previous trial found no difference in the primary outcome between IV and IM administration. Discussion: The difference between IV and IM routes of administration of widow spider antivenom is, at best, small and does not justify routinely choosing one route over the other. Furthermore, antivenom may provide no benefit over placebo.
DOI http://dx.doi.org/10.1093/qjmed/hcn048   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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