Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients

Victoria E. Anderson, Charles J. Gerardo, Malin Rapp-Olsson, Sean P. Bush, Michael E. Mullins, Spencer Greene, Eric A. Toschlog, Eugenia Quackenbush, S. Rutherfoord Rose, Richard B Schwartz, Nathan P. Charlton, Brandon Lewis, Kurt C. Kleinschmidt, Kapil Sharma, Eric J. Lavonas

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. Methods: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. Results: Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p =.025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. Conclusions: In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.

Original languageEnglish (US)
Pages (from-to)25-30
Number of pages6
JournalClinical Toxicology
Volume57
Issue number1
DOIs
StatePublished - Jan 2 2019

Fingerprint

Agkistrodon
Antivenins
Snake Bites
Extremities
Recovery
Placebos
Instrument scales
Snakes
Recovery of Function
Logistics
Proportional Hazards Models
Hazards
Linear Models
Therapeutics
Logistic Models
Clinical Trials

Keywords

  • Agkistrodon
  • antivenins
  • recovery of function
  • snake bites

ASJC Scopus subject areas

  • Toxicology

Cite this

Anderson, V. E., Gerardo, C. J., Rapp-Olsson, M., Bush, S. P., Mullins, M. E., Greene, S., ... Lavonas, E. J. (2019). Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients. Clinical Toxicology, 57(1), 25-30. https://doi.org/10.1080/15563650.2018.1491982

Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients. / Anderson, Victoria E.; Gerardo, Charles J.; Rapp-Olsson, Malin; Bush, Sean P.; Mullins, Michael E.; Greene, Spencer; Toschlog, Eric A.; Quackenbush, Eugenia; Rose, S. Rutherfoord; Schwartz, Richard B; Charlton, Nathan P.; Lewis, Brandon; Kleinschmidt, Kurt C.; Sharma, Kapil; Lavonas, Eric J.

In: Clinical Toxicology, Vol. 57, No. 1, 02.01.2019, p. 25-30.

Research output: Contribution to journalArticle

Anderson, VE, Gerardo, CJ, Rapp-Olsson, M, Bush, SP, Mullins, ME, Greene, S, Toschlog, EA, Quackenbush, E, Rose, SR, Schwartz, RB, Charlton, NP, Lewis, B, Kleinschmidt, KC, Sharma, K & Lavonas, EJ 2019, 'Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients', Clinical Toxicology, vol. 57, no. 1, pp. 25-30. https://doi.org/10.1080/15563650.2018.1491982
Anderson, Victoria E. ; Gerardo, Charles J. ; Rapp-Olsson, Malin ; Bush, Sean P. ; Mullins, Michael E. ; Greene, Spencer ; Toschlog, Eric A. ; Quackenbush, Eugenia ; Rose, S. Rutherfoord ; Schwartz, Richard B ; Charlton, Nathan P. ; Lewis, Brandon ; Kleinschmidt, Kurt C. ; Sharma, Kapil ; Lavonas, Eric J. / Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients. In: Clinical Toxicology. 2019 ; Vol. 57, No. 1. pp. 25-30.
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abstract = "Background: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. Methods: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. Results: Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p =.025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. Conclusions: In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.",
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AU - Bush, Sean P.

AU - Mullins, Michael E.

AU - Greene, Spencer

AU - Toschlog, Eric A.

AU - Quackenbush, Eugenia

AU - Rose, S. Rutherfoord

AU - Schwartz, Richard B

AU - Charlton, Nathan P.

AU - Lewis, Brandon

AU - Kleinschmidt, Kurt C.

AU - Sharma, Kapil

AU - Lavonas, Eric J.

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N2 - Background: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation. Methods: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group. A Cox proportional hazards model was used to compare time to full recovery on the Patient-Specific Functional Scale (PSFS) instrument between groups. Secondary analyses compared estimated mean PSFS scores using a generalized linear model and the estimated proportion of patients with full recovery at each time point using logistic regression. To evaluate for confounding, the main analysis was repeated using data from placebo-treated subjects. Results: Forty-five subjects were treated with FabAV at a median of 5.47 h after envenomation. Patients in the early treatment group had a significantly shorter time to full recovery than those treated late (median time: 17 versus 28 days, p =.025). Model-estimated PSFS scores were numerically higher at each time point in the early group. No difference was found between patients treated early versus late with placebo. Conclusions: In this secondary analysis of trial data, recovery of limb function was faster when Fab antivenom was administered soon after envenomation, as opposed to late administration.

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