Clinical utility of telavancin for treatment of hospital-acquired pneumonia: focus on non-ventilator-associated pneumonia

Abstract

Background

Hospital-acquired pneumonia (HAP) is the most common health care-associated infection contributing to death. Studies have indicated that there may be differences in the causative pathogens and outcomes of ventilator-associated pneumonia (VAP) and non-ventilator-associated pneumonia (NV-HAP). However, with limited NV-HAP-specific data available, treatment is generally based on data from studies of VAP. The Phase 3 Assessment of Telavancin for Treatment of Hospital-Acquired Pneumonia (ATTAIN) studies were two double-blind randomized controlled trials that demonstrated the non-inferiority of telavancin to vancomycin for treatment of Gram-positive HAP. We conducted a post hoc subgroup analysis of patients enrolled in the ATTAIN studies who had NV-HAP.

Methods

Data from the two ATTAIN studies were pooled, and patients with NV-HAP were analyzed. The all-treated (AT) population consisted of all randomized patients who received ≥1 dose of study medication, and the clinically evaluable (CE) population consisted of AT patients who were protocol-adherent or who died on or after study day 3, where death was attributable to the HAP episode under study. The primary endpoint was clinical response (cure, failure, or indeterminate) at the follow-up/test of cure visit, conducted 7–14 days after the end of therapy.

Results

A total of 1,076 patients (71.6% of overall ATTAIN AT population) had NV-HAP (533 and 543 patients in the telavancin and vancomycin treatment groups, respectively). Clinical cure rates in the CE population were similar for patients with NV-HAP treated with telavancin and vancomycin (83.1% [201/242] and 84.1% [233/277], respectively). In patients with methicillin-resistant Staphylococcus aureus isolated at baseline, cure rates in the CE population were 74.8% (77/103) for telavancin and 79.3% (96/121) for vancomycin. The incidence of adverse events, serious adverse events, and deaths in patients with NV-HAP was similar whether patients received telavancin or vancomycin.

Conclusion

This post hoc subgroup analysis of the ATTAIN studies demonstrated similar cure rates for telavancin and vancomycin for treatment of NV-HAP.

Keywords:

• nosocomial pneumonia
• Staphylococcus aureus
• methicillin-resistant Staphylococcus aureus

Acknowledgments

The ATTAIN studies were sponsored by Theravance, Inc. Medical writing support was provided by Emily Howard of Envision Scientific Solutions, funded by Theravance, Inc.

Disclosure

Ethan Rubinstein has served on advisory boards for Astellas, Atox Bio, Bayer, BiondVax, Pfizer, and Theravance, has served as a consultant for Roche and Theravance, and has received payment for lectures/speaker bureaus from Astellas, Bayer, and Pfizer. Martin E Stryjewski has served as a consultant for Astellas, Cempra, Cerexa, Furiex, Nabriva, PRA International, The Medicines Company, Theravance, and Trius, has received grants from Duke University (NIH), and has received other financial support (including reimbursement for travel expenses and/or manuscript preparation) from Cempra, JMI Laboratories, and Theravance. Steven L Barriere is an employee of, and holds equity securities of, Theravance, Inc.