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Recombinant Thrombin: Safety and Immunogenicity in Burn Wound Excision and Grafting

Greenhalgh, David G. MD, FACS*; Gamelli, Richard L. MD, FACS; Collins, Jay MD; Sood, Rajiv MD, FACS§; Mozingo, David W. MD; Gray, Todd E. MSPH**; Alexander, W Allan MD**

Journal of Burn Care & Research: May-June 2009 - Volume 30 - Issue 3 - p 371-379
doi: 10.1097/BCR.0b013e3181a28979
Original Articles

This study evaluated the safety, immunogenicity, and hemostatic effect of recombinant human Thrombin (rThrombin), in patients undergoing skin grafting for burns. This was a phase 2 multiple site, single-arm, open-label study in patients receiving partial- or full-thickness autologous grafts. rThrombin was applied using a spray applicator to newly excised wounds of 1 to 4% body surface area at 5 minutes intervals for up to 20 minutes, after point source bleeding was stopped. Adverse events, skin graft survival, and formation of anti-rThrombin antibodies were measured at baseline and Day 29. There were no deaths or study drug discontinuations. Adverse events occurred in 63 of 72 patients (88%), and were typical of sequelae of skin grafting. Hemostasis was achieved within 20 minutes after application of rThrombin in 65 of 71 patients (91.5%). Skin graft failure occurred in 4 patients (6%). At the day 29 evaluation, for those patients who returned, 88.9% had ≥90% graft survival. One patient (1 of 70, 1.4%) had specific, low titer antibodies to rThrombin at baseline, but no increase in titer posttreatment; a second patient (1 of 62, 1.6%), developed antibodies to rThrombin at day 29. None of the antibodies neutralized native human thrombin. In excised burn wounds, hemostasis at 20 minutes was achieved in 91.5% of patients and skin graft survival was excellent. There was a low rate of antibodies to rThrombin at baseline (1.4%) and a low rate of anti-rThrombin antibody formation at day 29 (1.6%). rThrombin was well tolerated when administered with a pump spray.

From the *Department of Surgery, University of California, Davis Medical Center, Sacramento; †Loyola University Medical Center, Maywood, Illinois; ‡Eastern Virginia Medical School, Norfolk, Virginia; §Richard M. Fairbanks Burn Center, Indianapolis, Indiana; ¶Shands Burn Center at the University of Florida College of Medicine, Gainesville; and **ZymoGenetics, Inc., Seattle, Washington.

Supported by ZymoGenetics, Inc., Seattle, Washington.

Address correspondence to David G. Greenhalgh, MD, University of California, Davis Medical Center, Northern California, 2315 Stockton Boulevard, Sacramento, California 95817.

© 2009 The American Burn Association