The EMA PRAC recommends against hydroxyethyl-starch (HES)
A recent PRAC review has recommended suspension of marketing authorisations for HES solutions for infusion across the EU. Results from drug utilisation studies were reviewed, along with benefit and risk data from clinical trials and observational studies as well as feedback from stakeholders and experts.
Intravenous fluids used for resuscitation of acutely ill patients replace plasma volume and prevent shock following acute blood loss. Intravenous fluids comprise colloid and crystalloid solutions. Colloid solutions increase the relative oncotic pressure of the intravascular space by including molecules that are too large to extravasate, such as starches. Crystalloid solutions are aqueous solutions of salts and other water-soluble molecules, such as saline or Ringer’s solutions. Colloid solutions, including those containing HES, are currently used when treatment with crystalloid solutions alone is not sufficient. Restrictions on the use of HES solutions in critically ill patients and those with sepsis and kidney injury were introduced in 2013 to reduce risk of kidney injury and mortality in these patient populations. These restrictions stated that HES solutions should not be used for more than 24 hours and that patients’ kidney function should be monitored after HES administration.
The PRAC review concluded that the 2013 restrictions have not been sufficiently effective. In view of the serious risks to certain patient populations, the PRAC has recommended suspension of the marketing authorisations for HES solutions and this was considered by the Coordination Group for Mutual Recognition and Decentralised Procedures (CMDh) 22–25 January, 2018. A position from the CMDh will be adopted and announced in due course.
This press release offers an important update to current fluid management best practice. There are alternative colloids that can be used to replace plasma volume which contain albumin, gelatin or dextran. Visit the Intravenous Fluids section for more information.
Update: In July 2018 the European Commission took the EU-wide, legally binding decision to continue the marketing of HES under new restrictions. Learn more about these restrictions and how the decision was made with our interactive HES timeline.
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