Second Multi-centre Intra-pleural Sepsis Trial

The second multi-centre intra-pleural sepsis trial (MIST2), to assess whether DNase or Alteplase improve pleural fluid drainage in pleural infection

What was this study about?

Pleural infection - an infection of the area around the lungs - can occur when people have lung diseases such as pneumonia. Doctors often try to drain the fluid around the lungs to try to treat this. But sometimes this can be hard to do successfully. Some people have to have an operation, and some people may die as a result of the infection. The drugs DNase and Alteplase, which are already used to treat other illnesses, might help to treat pleural infection. The MIST2 trial aimed to test whether these drugs were safe, and whether they could help to drain the fluid around the lungs. This trial was done in partnership with the Respiratory Trials Unit at the Churchill Hospital, Oxford.

What difference did this study make?

This study found that a combined therapy of Alteplase and DNase was effective in treating patients with pleural infections. Over the course of a week patients receiving both drugs saw a 30% reduction in fluid volume seen in their chest X-rays, compared to 17% for the placebo group. There was no effect above placebo for either drug on its own.

Type of study

Randomised trial

Contact details


Who funded the study?

This trial was funded by three pharmaceutical companies - Roche, Genentech and Boehringer Ingelheim. Roche supplied one of the trial drugs, and Genentech and Boehringer Ingelheim supplied the other trial drug.

When did it take place?

Recruitment began in December 2005 and closed in November 2008. Patients were followed up for one year.

Where did it take place?

In 11 hospitals around the UK - Oxford, Reading, Bristol, Swindon, Ipswich, Nottingham, Kent, Leeds, Hull and Manchester.

Who was included?

People over 18 years of age who had a pleural infection (for example empyema) that needed to be drained. We recruited 210 people to this trial.