Real-World Evidence Studies of Oritavancin Use in Gram-Positive Infections Augment Randomized Controlled Trials to Address Clinical and Economic Outcomes

Role or oritavancin and dalbavancin in acute bacterial skin and skin structure infections and other potential indications

PURPOSE OF REVIEW

To discuss the currently available evidence about the use oritavancin and dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and for other potential indications.

RECENT FINDINGS

In this review, we briefly summarize the available data on efficacy (from randomized controlled trials) and on effectiveness and cure rates (from observational studies) pertaining to the use of oritavancin and dalbavancin either for ABSSSI or for other indications.

SUMMARY

Oritavancin and dalbavancin are valid options for outpatient therapy and early discharge in patients with ABSSSI, especially when adherence to oral therapy cannot be guaranteed or no oral choices are available. Furthermore, it is worth noting that a non-negligible portion (sometimes the majority) of oritavancin and dalbavancin use in available real-life experiences is for indications other than ABSSSI, especially for Gram-positive osteomyelitis and endocarditis. The number of studies on the use of long-acting lipoglycopeptides for these currently off-label indications is rapidly increasing and will help to further optimize the use of these peculiar antibiotics in the forthcoming future.

Efficacy and safety of oritavancin for the treatment of acute bacterial skin and skin-structure infections: a systematic review and meta-analysis

OBJECTIVES

This study aimed to evaluate the efficacy and safety of oritavancin (ORI) versus comparators for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs) based on available clinical studies.

METHODS

PubMed, Cochrane Library and Embase were searched from database inception to 28 July 2020 to identify clinical studies assessing the efficacy and safety of ORI and comparator antibiotics for the treatment of ABSSSIs. Primary efficacy outcome, investigator-assessed clinical cure, lesion size reduction ≥20%, additional post-treatment antibiotics, and 30-day emergency room (ER) visits and readmission were assessed as efficacy outcomes. Adverse events (AEs) and mortality were assessed as safety outcomes. I² statistic was calculated for heterogeneity, and a fixed-effects or random-effects model was used for estimation of the risk ratio (RR).

RESULTS

A total of 9213 patients from two randomised clinical trials (RCTs) and four cohort studies were included in this meta-analysis. ORI was statistically non-inferior to control agents in all efficacy and safety outcomes. Moreover, ORI significantly reduced the occurrence of 30-day readmission (RR = 0.42; P = 0.0004) and drug-related AEs (RR = 0.78; P = 0.002). In the subgroup analysis, ORI also had a lower rate of 30-day ER visits in the outpatient setting (RR = 0.34; P < 0.00001).

CONCLUSION

ORI was not inferior to comparators for the treatment of ABSSSIs. Meanwhile, it showed advantages in reducing the rate of readmission and drug-related AEs. More high-quality and large-scale RCTs are required to further confirm the efficacy and safety of ORI. [Trial registration: PROSPERO ID: CRD42020201942].

A Real-World Assessment of Clinical Outcomes and Safety of Eravacycline: A Novel Fluorocycline

Background

Eravacycline is a novel fluorocycline approved for treatment of intraabdominal infections, with a broad spectrum of activity against a range of pathogens including multidrug-resistant species, including ESBL- or KPC-producing isolates. It is approved for twice-daily dosing with no need for adjustment in renal dysfunction. In the concomitant administration with CYP 3A4-inducing drugs, eravacycline dosing should be modified.

Objective

To evaluate the efficacy and safety of eravacycline in a range of infections such as intraabdominal infections, pneumonia and diabetic foot infections in seriously ill patients.

Methods

A retrospective observational cohort study using electronic patient records of 50 consecutive patients administered eravacycline during inpatient acute care admission or as part of outpatient antibiotic therapy (OPAT).

Results

Therapy of 1.5 mg/kg q24h was initiated in the hospital in most patients, although some of the less sick were managed in the office or OPAT setting. All patients concluded their management outside of the hospital. Of the 50 patients, 47 (94%) achieved clinical resolution of their infection and 3 (6%) clinical failures occurred. Only three (6%) patients did not have comorbidities, three had a single comorbidity (6%), and the majority (88%) of patients had two or more comorbidities. Most common infections were intraabdominal (36%), pneumonia (18%), diabetic foot (12%), spontaneous bacterial peritonitis (8%) and empyema (8%). Almost half of infections had more than one pathogen isolated, and resistant isolates were frequent. The drug was well tolerated with only two reports of nausea, which did not result in treatment discontinuation, and in 30 days of post-eravacycline therapy only one case of Clostridiodes difficile.

Conclusions

In this real-world setting, eravacycline demonstrated a similar high level of clinical efficacy as seen in clinical trials, 94%, in a variety of infections, including against multidrug-resistant bacteria, and was well tolerated.