The ATTAIN program compared telavancin (TLV), an investigational lipoglycopeptide antibiotic, with vancomycin (VAN) for treatment of hospital-acquired pneumonia (HAP) due to Gram-positive pathogens including MRSA. This subgroup analysis examined the baseline characteristics and clinical outcomes in bacteremic HAP cases.
ATTAIN 1 and 2 were methodologically identical, randomized, double-blind, Phase 3 studies. Adult patients with HAP due to presumed or confirmed Gram-positive pathogens were randomized (1:1) to TLV 10 mg/kg IV q24 h or VAN 1 g IV q12 h (adjusted per site-specific guidelines) for 7 to 21 days. The modified all-treated (MAT) population consisted of patients who received ≥ 1 dose of study medication and had a pneumonia-causing pathogen identified from blood or same pathogen in lung and blood with identical susceptibility profiles. Clinical outcomes were assessed at test-of-cure (TOC) 7–14 days after end of study treatment.
All MAT patients (N = 73) were included in this analysis. At baseline, more TLV patients than VAN patients were in the intensive care unit (TLV 74%, VAN 62%) and had ventilator-associated pneumonia (TLV 59%, VAN 44%) whereas APACHE II scores were similar between groups (mean ± SD APACHE II score, TLV 16 ± 6, VAN 17 ± 6). S. aureus was the most common pathogen (TLV 76%, VAN 69%) and included MRSA (TLV 41%, VAN 49%). Cure rates for TLV and VAN were 44% and 36% respectively (Difference TLV-VAN [95% CI] = 7.3% [−15.9%, 30.5%]). Incidences of adverse events (AE) were similar between groups, except for nausea (TLV 21%, VAN 3%) and vomiting (TLV 15%, VAN, 0%). Proportions of patients who discontinued the study medication due to AE were similar (TLV 12%, VAN 13%).
TLV achieved similar cure rates compared to VAN in a subgroup of ATTAIN patients with bacteremic HAP. The safety profiles of TLV and VAN were mostly comparable among these patients.
TLV has the potential to provide a useful alternative for treatment of patients with bacteremic HAP and randomized controlled trials are warranted.
Ethan Rubinstein, Grant monies (from industry related sources) GRC: Cubist, Theravance, Inc.ALL: Ortho-McNeill, Cubist, Cerexa, Targanta, Optimer, Theravance, Inc.CL: PfizerMS: Theravance, Inc.; Shareholder SLB: Theravance, Inc.FG: Theravance, Inc.; Employee SLB: Theravance, Inc.FG: Theravance, Inc.; Consultant fee, speaker bureau, advisory committee, etc. ER: Theravance, Inc.; Astellas, Pfizer, Bayer, Wyeth, Replidyne, Ortho-McNeill, Sanofi-Aventis.GRC: Cerexa, Merck, Pfizer, Cempra, Astellas.CL: Theravance, Inc., Pfizer, Merck, Astra-Zeneca, Bayer; Other Honoraria. MS: Astellas.CL: Pfizer, Merck, Astra-Zeneca, Bayer; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Telavancin for treatment of hospital-acquired pneumonia