Digoxin antibody fragment, antigen binding (Fab), treatment of preeclampsia in women with endogenous digitalis-like factor

A secondary analysis of the DEEP Trial

Garrett K. Lam, Moana Hopoate-Sitake, C. David Adair, Vardaman M. Buckalew, Donna D. Johnson, David F. Lewis, Christopher J. Robinson, George Saade, Steven W. Graves

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Endogenous digitalis-like factors (EDLFs) are elevated in women with preeclampsia, and the use of an anti-digoxin antibody Fab (DIF) in women with preeclampsia who were remote from term reduced maternal blood pressure and preserved renal function. The objective was to determine whether DIF treatment in women with severe preeclampsia in association with positive EDLFs in maternal serum improves maternal-perinatal outcomes. Study Design: This was a planned secondary analysis from a randomized, placebo-controlled, double-blind study of DIF in women with severe preeclampsia with positive EDLF status that was managed expectantly between 23 weeks 5 days and 34 weeks' gestation (19 women received placebo, and 17 women received DIF). Primary outcome variables were a change in creatinine clearance and the use of antihypertensives. Secondary outcomes were maternal and perinatal complications. Results: Women with positive EDLFs who received DIF had an attenuated decline in creatinine clearance from baseline compared with placebo (-4.5 ± 12.9 vs -53.2 ± 12.6 mL/min; P =.005). In this same group, the use of antihypertensives (the other primary outcome) was lower but not significantly so (41% vs 63%; P =.12). However, women who were treated with DIF had a lower rate of pulmonary edema (1/17 vs 6/19 women; P =.035) and lower rates of neonatal intraventricular hemorrhage (DIF: 0/17 women vs placebo: 5/19 women; P =.015). Conclusion: In women with severe preeclampsia who were remote from term who were EDLF positive, the use of DIF was associated with improved maternal and neonatal outcome. These findings suggest the need for a large multicenter trial that would evaluate the benefits of DIF in the treatment of women with severe preeclampsia who are remote from term and with positive EDLF status.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume209
Issue number2
DOIs
StatePublished - Aug 2013

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Immunoglobulin Fragments
Digoxin
Pre-Eclampsia
Antigens
Antibodies
Mothers
Therapeutics
Placebos
digoxin-like factors
Antihypertensive Agents
Creatinine
Pulmonary Edema
Double-Blind Method
Multicenter Studies
Anti-Idiotypic Antibodies

Keywords

  • creatinine clearance
  • DEEP Trial
  • Digibind
  • intraventricular hemorrhage
  • pulmonary edema
  • sodium pump

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Digoxin antibody fragment, antigen binding (Fab), treatment of preeclampsia in women with endogenous digitalis-like factor : A secondary analysis of the DEEP Trial. / Lam, Garrett K.; Hopoate-Sitake, Moana; Adair, C. David; Buckalew, Vardaman M.; Johnson, Donna D.; Lewis, David F.; Robinson, Christopher J.; Saade, George; Graves, Steven W.

In: American Journal of Obstetrics and Gynecology, Vol. 209, No. 2, 08.2013.

Research output: Contribution to journalArticle

Lam, Garrett K. ; Hopoate-Sitake, Moana ; Adair, C. David ; Buckalew, Vardaman M. ; Johnson, Donna D. ; Lewis, David F. ; Robinson, Christopher J. ; Saade, George ; Graves, Steven W. / Digoxin antibody fragment, antigen binding (Fab), treatment of preeclampsia in women with endogenous digitalis-like factor : A secondary analysis of the DEEP Trial. In: American Journal of Obstetrics and Gynecology. 2013 ; Vol. 209, No. 2.
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