MAGMAT
Trial question
What is the effect of magnesium sulfate in patients with TTP?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
59.0% female
41.0% male
N = 73
73 patients (43 female, 30 male).
Inclusion criteria: adult patients with a clinical diagnosis of TTP.
Key exclusion criteria: pregnancy; suspected thrombotic microangiopathy not related to TTP (HUS, drug-induced thrombotic microangiopathy, HELLP syndrome, preeclampsia, or metastatic cancer with bone marrow involvement).
Interventions
N=35 magnesium sulfate (at a dose of 6 g IV followed by a continuous infusion of 6 g/24 hours for 3 days).
N=38 placebo (matching glucose infusion for 3 days).
Primary outcome
Median time to platelet normalization
4 days
4 days
4.0 days
3.0 days
2.0 days
1.0 days
0.0 days
Magnesium
sulfate
Placebo
No significant
difference ↔
No significant difference in median time to platelet normalization (4 days vs. 4 days; HR 0.93, 95% CI 0.58 to 1.48).
Secondary outcomes
No significant difference in death at day 90 (5% vs. 11%; RR 2.17, 95% CI 0.42 to 11.13).
No significant difference in recurrence of TTP (6% vs. 9%; RR 1.63, 95% CI 0.29 to 9.18).
No significant difference in median time to hospital discharge (9 days vs. 13 days; HR 0.63, 95% CI 0.39 to 1.01).
Safety outcomes
No significant differences in ≥ 1 serious adverse reactions, death.
Conclusion
In adult patients with a clinical diagnosis of TTP, magnesium sulfate was not superior to placebo with respect to median time to platelet normalization.
Reference
Lara Zafrani, Emmanuel Canet, Anouk Walter-Petrich et al. Magnesium sulphate in patients with thrombotic thrombocytopenic purpura (MAGMAT): a randomised, double-blind, superiority trial. Intensive Care Med. 2023 Nov;49(11):1293-1304.
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