Polymyxin B Hemoperfusion Shows Mortality Benefit in endotoxic Septic Shock: Lancet
Blood purification using polymyxin B demonstrated a potential reduction in mortality among patients with septic shock who had high endotoxin activity, suggesting benefit in this high-risk subgroup. The study was published in The Lancet journal by Prof. Javier AN and fellow researchers.
Polymyxin B hemoadsorption was found to have a high probability of reduced mortality at 28 days as well as 90 days in endotoxic septic shock patients, indicating the potential for polymyxin B hemoadsorption as an adjunctive therapy for this high-risk population. Endotoxic septic shock is defined as an increased endotoxin activity with resulting dysfunction in multiple organ systems, resulting in high mortality rates among patients, even with the advancement in the management of shock. This phase 3 randomized trial aimed to determine the potential for the survival outcome of endotoxin removal by polymyxin B hemoadsorption.
This open-label, randomized, controlled phase 3 trial was conducted across 19 hospitals in the United States. Adult patients aged 18 years or older with septic shock requiring vasopressors, evidence of multiple organ dysfunction, and endotoxin activity levels between 0.60 and 0.89 units were eligible.
Between September 30, 2019, and April 10, 2025, a total of 14,890 patients were screened, of whom 157 were enrolled. Patients were randomized in a 2:1 ratio, with 106 assigned to the polymyxin B group and 51 to the control group. Among participants, 66 (42%) were women and 91 (58%) were men.
Key findings:
A total of 157 patients were randomized (106 polymyxin B; 51 control).
At 28 days, mortality was 39% (41/106) in the polymyxin B group versus 45% (23/51) in the control group.
The posterior probability of benefit at 28 days was 95.3%.
The adjusted odds ratio was 0.67 (95% credible interval 0.39–1.08).
At 90 days, the posterior probability of benefit increased to 99.4%.
The adjusted odds ratio at 90 days was 0.54 (95% credible interval 0.32–0.87).
Serious adverse events occurred in 30% (30/100) of polymyxin B patients versus 22% (11/51) in controls.
Two treatment-related serious adverse events (2%) were reported in the polymyxin B group.
Polymyxin B Hemoadsorption had a high probability of reducing mortality among patients with endotoxic septic shock after 28 and 90 days. This indicates that the therapy could be useful for the high-risk group of septic shock patients.
Reference:
Neyra, J. A., Legrand, M., Tidswell, M. A., Al-Khafaji, A., Galphin, C., Rains, R., Davison, D., Tolwani, A., Chen, J. T., Bender, W. S., Busse, L. W., Meena, N. K., DellaVolpe, J., Williams, G. W., Kashani, K. B., Gunnerson, K. J., McMahon, B. A., Eaton, J., Khan, S., Kohli-Seth, R., … Kellum, J. A. (2026). Polymyxin B haemoadsorption in endotoxic septic shock (Tigris): a multicentre, open-label, Bayesian, randomised, controlled, phase 3 trial. The Lancet. Respiratory medicine, S2213-2600(26)00047-0. Advance online publication. https://doi.org/10.1016/S2213-2600(26)00047-0
