Exploratory Network Meta-Analysis of Antibiotics for the Treatment of Complicated Urinary Tract Infections in Adults
Author(s)
Vanesa Huertas Carrera, PharmD, MSc.
Excellent Pharma Ltd, York, United Kingdom.
Excellent Pharma Ltd, York, United Kingdom.
OBJECTIVES: To assess the comparative effectiveness of antibiotics used in the treatment of complicated urinary tract infections (cUTIs) in adult populations.
METHODS: A targeted search of ClinicalTrials.gov was conducted to identify completed phase III head-to-head clinical trials reporting relevant outcomes. The primary endpoint was defined as the proportion of patients achieving both clinical cure and microbiological eradication, relative to the number of analysed participants. Network meta-analyses (NMAs) were performed without adjustment for potential effect modifiers or risk of bias. All analyses were carried out using the NMAStudio software.
RESULTS: A total of sixteen eligible trials were identified and categorized into three discrete treatment networks: Network A (NCT01970371, NCT02486627, NCT03840148), Network B (NCT01014013, NCT01345929, NCT01978938, NCT03032510, NCT03357614, NCT03788967), and Network C (NCT01595438, NCT01599806, NCT01644643, NCT02166476, NCT02168946, NCT02714595, NCT02753946). Statistically significant differences in treatment effects were observed for 8 out of 21 pairwise comparisons in Network B, 1 out of 21 in Network C, and none in Network A. Notable findings include significant benefit for meropenem-vaborbactam compared to piperacillin-tazobactam (OR 4.05, 95% CI: 1.11-14.77), and for ceftolozane-tazobactam compared to both eravacycline (OR 2.03, 95% CI: 1.29-3.22) and levofloxacin (OR 1.54, 95% CI: 1.12-2.10).
CONCLUSIONS: This exploratory NMA underscores the breadth of existing evidence assessing antibiotic efficacy in cUTIs, while also highlighting the dependence of clinical effectiveness on combinations involving β-lactamase inhibitors. These findings reinforce the need for more robust, prospectively designed NMAs to comprehensively address the comparative effectiveness landscape in this domain. Moreover, continued innovation in antimicrobial development remains essential, consistent with its recognition as a societal priority under the ‘NEED Framework’ proposed by the Belgian Health Care Knowledge Centre in 2024.
METHODS: A targeted search of ClinicalTrials.gov was conducted to identify completed phase III head-to-head clinical trials reporting relevant outcomes. The primary endpoint was defined as the proportion of patients achieving both clinical cure and microbiological eradication, relative to the number of analysed participants. Network meta-analyses (NMAs) were performed without adjustment for potential effect modifiers or risk of bias. All analyses were carried out using the NMAStudio software.
RESULTS: A total of sixteen eligible trials were identified and categorized into three discrete treatment networks: Network A (NCT01970371, NCT02486627, NCT03840148), Network B (NCT01014013, NCT01345929, NCT01978938, NCT03032510, NCT03357614, NCT03788967), and Network C (NCT01595438, NCT01599806, NCT01644643, NCT02166476, NCT02168946, NCT02714595, NCT02753946). Statistically significant differences in treatment effects were observed for 8 out of 21 pairwise comparisons in Network B, 1 out of 21 in Network C, and none in Network A. Notable findings include significant benefit for meropenem-vaborbactam compared to piperacillin-tazobactam (OR 4.05, 95% CI: 1.11-14.77), and for ceftolozane-tazobactam compared to both eravacycline (OR 2.03, 95% CI: 1.29-3.22) and levofloxacin (OR 1.54, 95% CI: 1.12-2.10).
CONCLUSIONS: This exploratory NMA underscores the breadth of existing evidence assessing antibiotic efficacy in cUTIs, while also highlighting the dependence of clinical effectiveness on combinations involving β-lactamase inhibitors. These findings reinforce the need for more robust, prospectively designed NMAs to comprehensively address the comparative effectiveness landscape in this domain. Moreover, continued innovation in antimicrobial development remains essential, consistent with its recognition as a societal priority under the ‘NEED Framework’ proposed by the Belgian Health Care Knowledge Centre in 2024.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO117
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Infectious Disease (non-vaccine), Urinary/Kidney Disorders