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<p>Septic shock driven by endotoxemia is associated with high mortality despite advances in supportive care. Polymyxin B hemoperfusion (PMX-HP) selectively removes circulating endotoxin and has shown variable efficacy in randomized trials. While earlier studies, such as EUPHAS, suggested benefit, subsequent trials, including ABDO-MIX and EUPHRATES, yielded neutral results, partly due to heterogeneous patient selection. The recently completed TIGRIS trial addressed these limitations by enrolling septic shock patients with intermediate endotoxin activity (EAA: 0.60–0.89) and high multiple organ dysfunction syndrome (MODS &gt; 9) using a Bayesian design. In 151 evaluable patients, PMX-HP achieved the primary endpoint, with a 95.3% posterior probability of 28-day survival benefit (adjusted odds ratio [OR]: 0.67; absolute risk reduction [ARR] 6.4%). At 90&#xa0;days, mortality reduction was greater (ARR: 17.4%; adjusted OR: 0.54; &gt; 99% posterior probability of benefit), corresponding to a number needed to treat of 8.1. These results support the targeted use of PMX-HP in a biomarker-defined subgroup and may facilitate broader regulatory approval.</p>

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TIGRIS and EUPHRATES eventually join and provide new evidence: a narrative review of the polymyxin B hemoperfusion

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Toshiaki Iba,
  • Julie Helms,
  • Isao Nagaoka,
  • Michio Mineshima,
  • Ricard Ferrer

摘要

Septic shock driven by endotoxemia is associated with high mortality despite advances in supportive care. Polymyxin B hemoperfusion (PMX-HP) selectively removes circulating endotoxin and has shown variable efficacy in randomized trials. While earlier studies, such as EUPHAS, suggested benefit, subsequent trials, including ABDO-MIX and EUPHRATES, yielded neutral results, partly due to heterogeneous patient selection. The recently completed TIGRIS trial addressed these limitations by enrolling septic shock patients with intermediate endotoxin activity (EAA: 0.60–0.89) and high multiple organ dysfunction syndrome (MODS > 9) using a Bayesian design. In 151 evaluable patients, PMX-HP achieved the primary endpoint, with a 95.3% posterior probability of 28-day survival benefit (adjusted odds ratio [OR]: 0.67; absolute risk reduction [ARR] 6.4%). At 90 days, mortality reduction was greater (ARR: 17.4%; adjusted OR: 0.54; > 99% posterior probability of benefit), corresponding to a number needed to treat of 8.1. These results support the targeted use of PMX-HP in a biomarker-defined subgroup and may facilitate broader regulatory approval.