Beneficial effects of immunotherapy in human sepsis and septic shock have not been demonstrated despite animal evidence and immediate hemodyamic improvements suggesting that benefits would occur. This may be related to the complex interaction of cytokines with each other and with other drugs such as sympathomimetics, or real benefits may be concealed by the limitations of clinical trials in human multisystem disease of variable severity. The high cost of such drugs means that approval for use in multisystem disease is unlikely in the absence of demonstration of improved survival. Although these novel biological immunotherapies do have a role to play in conditions other than infection and sepsis, the approved indications are currently limited.
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