A BAYESIAN META-ANALYSIS OF THE EFFICACY OF SIX ANTIMICROBIAL AGENTS FOR CONFIRMED STAPHYLOCOCCUS AUREUS COMPLICATED SKIN AND SOFT-TISSUE INFECTIONS (CSSTIS)

Author(s)

J Floris S Logman, PharmD, Research Associate1, Maarten Jacob Treur, MSc, Research Associate1, Bram G. Verheggen, PharmD, Research Consultant1, Bart M. S. Heeg, MSc, Senior Research Consultant1, Jennifer Stephens, PharmD, Clinical Director2, Julie Spiesser, MSc, Outcomes Research Director3, Damian Simoneau, MSc, Senior Medical Manager Antibacterials Europe3, Seema Haider, MSc, Sr Director4, Dilip Nathwani, MB, FRCP, Consultant Physician5, Ben A Van Hout, PhD, Professor11Pharmerit Europe, Rotterdam, Netherlands; 2 Pharmerit North America LLC, Bethesda, MD, USA; 3 Pfizer PIO, Paris Cedex 14, France; 4 Pfizer Inc, Groton, CT, USA; 5 Ninewells Hospital & Medical School, Dundee, United Kingdom

OBJECTIVES: Dalbavancin is a new, once weekly, intravenous, glycopeptide antibacterial. In phase III trial, dalbavancin demonstrated comparable efficacy versus linezolid in complicated skin and soft tissue infections (cSSTIs). Teicoplanin is a key antimicrobial comparator in Europe, therefore an indirect comparison based on available published efficacy was performed in “all” Staphylococcus aureus (SA) patients. A Bayesian meta-analysis was conducted to compare success rates of antibacterials versus teicoplanin in cSSTIs due to SA.  METHODS: Medline, Embase, and Cochrane databases were searched to identify clinical trials on dalbavancin, daptomycin, linezolid, telavancin, teicoplanin, tigecycline, and vancomycin in cSSTIs. Two independent reviewers completed data extraction, study quality, and heterogeneity assessment. Pooled efficacy estimates were generated based on clinical and microbiological success rates for the all SA cSSTI patients. A random effects model was used with outcome predicted by medication and confounders of success definition, dosing, age and gender. The impact of base case confounders, fixed vs random effects models and doses was investigated in sensitivity analyses.  RESULTS: Out of 36 articles, reporting on 11 trials, 6 treatments and 17 treatment arms (n= 955) were included. Pooled success rate for teicoplanin was 88.6% (71.7;97.2) and differences versus comparators for the base case analysis are: vancomycin -9.4% (-47.1;15.5), linezolid +0.4% (-12.9;17.6), tigecycline -6% (-9.7;17.7), dalbavancin +0.5% (-12.9;16.8), and telavancin -5% (-43.7;21.5). Success rates for dalbavancin and linezolid were numerically higher versus teicoplanin, although differences were not significant. These findings were consistent in a variety of sensitivity analyses.  CONCLUSIONS: Dalbavancin demonstrated high microbiological success rates, comparable to teicoplanin and other antimicrobials in SA cSSTI. These data are consistent with the results of the phase III study versus linezolid. In the context of the limited numbers of patients available for some agents and the indirect nature of the comparison; further analyses are needed in this populations.

Conference/Value in Health Info

2008-11, ISPOR Europe 2008, Athens, Greece

Value in Health, Vol. 11, No. 6 (November 2008)

Code

PIN1

Topic

Clinical Outcomes

Topic Subcategory

Comparative Effectiveness or Efficacy

Disease

Infectious Disease (non-vaccine), Respiratory-Related Disorders

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