Efficacy and Safety of Inhaled Levofloxacin vs. Other Inhaled Antibiotics in the Treatment of Adults With Cystic Fibrosis and Chronic Pseudomonas Aeruginosa Lung Infection: An Updated Network Meta-Analysis
Author(s)
Beatriz Costa, MSc1, Ricardo Amaral, MSc1, Ana Penedones, PhD1, David Ramírez Alcántara, PharmD2, Diogo Mendes, PhD1, Carlos Alves, PhD3.
1Clevidence, Oeiras, Portugal, 2Medical & Technical Affairs, Chiesi Spain & Portugal, Barcelona, Spain, 3Assistant Professor, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
1Clevidence, Oeiras, Portugal, 2Medical & Technical Affairs, Chiesi Spain & Portugal, Barcelona, Spain, 3Assistant Professor, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
OBJECTIVES: This bayesian network meta-analysis updated the comparative efficacy and safety of inhaled levofloxacin versus other inhaled antibiotics approved in Europe in the treatment of chronic Pseudomonas aeruginosa lung infection in adults with cystic fibrosis.
METHODS: PUBMED and EMBASE were searched (until January 2025) to identify trials evaluating inhaled antibiotics (levofloxacin, tobramycin [powder - TIP; solution - TIS], colistimethate sodium [colistin], and aztreonam). Outcomes assessed (at weeks 4 and 24) were relative and absolute percent changes in forced expiratory volume in 1 second (FEV1%) predicted, P. aeruginosa sputum density, CF questionnaire-revised respiratory symptoms score (CFQ-R RSS), respiratory exacerbations, hospitalizations (any and respiratory cause), additional antibiotics use, total and serious adverse events, and withdrawal rates.
RESULTS: Twelve studies were included. At week 4, levofloxacin reduced the risk of additional antibiotics use (0.47 [95% CrI: 0.31; 0.70]) and was more effective in improving quality of life (CFQ-R RSS: 2.78 [95% CrI: 0.24; 5.33]) than TIS. Levofloxacin reduced the risk of hospitalizations for any cause versus aztreonam (0.26 [95% CrI: 0.06; 0.94]). At week 24, levofloxacin was associated with a lower reduction in P. aeruginosa sputum density compared to TIP (0.54 [95% CrI: 0.08, 1.01]), but was comparable to TIS (0.12 [95% CrI: -0.2; 0.48]). Levofloxacin increased absolute FEV1% (5.65 [95% CrI: 0.90; 10.44]), and reduced the risk of hospitalizations for any cause (0.61 [95% CrI: 0.38; 0.99]) and for respiratory cause (0.55 [95% CrI: 0.33; 0.90]), versus TIS. Levofloxacin was associated with a lower risk of respiratory exacerbations versus colistin (0.56 [95% CrI: 0.31; 0.98]), and a lower risk of serious adverse events than TIS (0.59 [95% CrI: 0.37; 0.95]).
CONCLUSIONS: Overall, the results suggest that levofloxacin may be more effective than TIS, and comparable to TIP, aztreonam and colistin, for the treatment of adults with CF and chronic P. aeruginosa lung infection.
METHODS: PUBMED and EMBASE were searched (until January 2025) to identify trials evaluating inhaled antibiotics (levofloxacin, tobramycin [powder - TIP; solution - TIS], colistimethate sodium [colistin], and aztreonam). Outcomes assessed (at weeks 4 and 24) were relative and absolute percent changes in forced expiratory volume in 1 second (FEV1%) predicted, P. aeruginosa sputum density, CF questionnaire-revised respiratory symptoms score (CFQ-R RSS), respiratory exacerbations, hospitalizations (any and respiratory cause), additional antibiotics use, total and serious adverse events, and withdrawal rates.
RESULTS: Twelve studies were included. At week 4, levofloxacin reduced the risk of additional antibiotics use (0.47 [95% CrI: 0.31; 0.70]) and was more effective in improving quality of life (CFQ-R RSS: 2.78 [95% CrI: 0.24; 5.33]) than TIS. Levofloxacin reduced the risk of hospitalizations for any cause versus aztreonam (0.26 [95% CrI: 0.06; 0.94]). At week 24, levofloxacin was associated with a lower reduction in P. aeruginosa sputum density compared to TIP (0.54 [95% CrI: 0.08, 1.01]), but was comparable to TIS (0.12 [95% CrI: -0.2; 0.48]). Levofloxacin increased absolute FEV1% (5.65 [95% CrI: 0.90; 10.44]), and reduced the risk of hospitalizations for any cause (0.61 [95% CrI: 0.38; 0.99]) and for respiratory cause (0.55 [95% CrI: 0.33; 0.90]), versus TIS. Levofloxacin was associated with a lower risk of respiratory exacerbations versus colistin (0.56 [95% CrI: 0.31; 0.98]), and a lower risk of serious adverse events than TIS (0.59 [95% CrI: 0.37; 0.95]).
CONCLUSIONS: Overall, the results suggest that levofloxacin may be more effective than TIS, and comparable to TIP, aztreonam and colistin, for the treatment of adults with CF and chronic P. aeruginosa lung infection.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO92
Topic
Clinical Outcomes, Epidemiology & Public Health, Study Approaches
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Genetic, Regenerative & Curative Therapies, Infectious Disease (non-vaccine), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)