エンドトキシン吸着療法の歴史と今後の展開

抄録

 Toraymyxin^® (Toray Medical Co., Ltd, Tokyo, Japan) has been developed as a direct hemoperfusion column that contains polymyxin B-immobilized fiber to bind endotoxins in the patients’ blood. Toraymyxin was approved by the Japanese National Health Insurance system for the treatment of endotoxemia and septic shock in 1994. We reviewed and analyzed clinical history and evidence of Toraymyxin, and assessed the current status of Toraymyxin use for the treatment of severe sepsis and septic shock.

 Our review shows that Toraymyxin appeared to be effective in improving hemodynamics and respiratory function in septic shock requiring emergency abdominal surgery. The recent large-scale RCTs could not demonstrate whether prognosis is improved by Toraymyxin. The clinical studies based on large-scale data-base from Japan revealed that Toraymyxin appeared to have a survival benefit in patients with severe condition of septic shock. We also commented on the revised version of health insurance adaptation of Toraymyxin in April, 2020.