A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism - the RAVE study Isbister , Geoff en_US Brown, SGA en_US Miller, M en_US Tankel, A en_US Macdonald, E en_US Stokes, B en_US Ellis, R en_US Nagree, Y en_US Wilkes, GJ en_US James, R en_US Holdgate, Anna en_US Short, Alison en_US 2021-11-25T17:44:33Z 2021-11-25T17:44:33Z 2008 en_US
dc.description.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. en_US
dc.identifier.issn 1460-2393 en_US
dc.language English
dc.language.iso EN en_US
dc.rights CC BY-NC-ND 3.0 en_US
dc.rights.uri en_US
dc.source Legacy MARC en_US
dc.title A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism - the RAVE study en_US
dc.type Journal Article en
dcterms.accessRights metadata only access
dspace.entity.type Publication en_US
unsw.identifier.doiPublisher en_US
unsw.relation.faculty Medicine & Health
unsw.relation.ispartofissue 7 en_US
unsw.relation.ispartofjournal Quarterly Journal of Medicine en_US
unsw.relation.ispartofpagefrompageto 557-565 en_US
unsw.relation.ispartofvolume 101 en_US
unsw.relation.originalPublicationAffiliation Isbister , Geoff en_US
unsw.relation.originalPublicationAffiliation Brown, SGA en_US
unsw.relation.originalPublicationAffiliation Miller, M en_US
unsw.relation.originalPublicationAffiliation Tankel, A en_US
unsw.relation.originalPublicationAffiliation Macdonald, E en_US
unsw.relation.originalPublicationAffiliation Stokes, B en_US
unsw.relation.originalPublicationAffiliation Ellis, R en_US
unsw.relation.originalPublicationAffiliation Nagree, Y en_US
unsw.relation.originalPublicationAffiliation Wilkes, GJ en_US
unsw.relation.originalPublicationAffiliation James, R en_US
unsw.relation.originalPublicationAffiliation Holdgate, Anna en_US
unsw.relation.originalPublicationAffiliation Short, Alison, Centre for Clinical Governance Research in Health, Faculty of Medicine, UNSW en_US
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