Telavancin for the treatment of hospital-acquired pneumonia: findings from the ATTAIN studies

Abstract

Treatment options for hospital-acquired pneumonia caused by Gram-positive organisms are far from ideal. The increase in vancomycin MICs among methicillin-resistant Staphylococcus aureus (MRSA) isolates, and the slow bactericidal action and poor lung penetration of vancomycin have driven the search for an alternative agent. Telavancin, a once-daily lipoglycopeptide, displays strong bactericidal activity against S. aureus. Two large Phase III randomized trials have recently compared intravenous telavancin (10mg/kg every 24 h) with vancomycin (1 g intravenously every 12 h) for 7–21 days for the treatment of hospital-acquired pneumonia caused by Gram positives. No significant differences were observed in the cure rates in the all-treated (n = 1503), the clinically evaluable (n = 654) and the microbiologically evaluable (n =480) populations. Telavancin performed better than vancomycin in patients with monomicrobial S. aureus pneumonia (84.2 vs 74.3%; 95% CI: 0.7–19.1), with MRSA (81.8 vs 74.1%; 95% CI: –3.5 to 19.3), and with strains having vancomycin MICs ≥1µg/ml (87.1 vs 74.3; 95% CI: 0.5–23). The rate of adverse events, including serious adverse events, was similar in both groups, with a slightly higher rate of serum creatinine increase in the telavancin-treated group. Based on these results, telavancin (already approved for this indication by the EMA) could certainly be added to the current treatment options, particularly in patients with MRSA pneumonia.

Keywords::

• hospital-acquired pneumonia
• MRSA
• Staphylococcus aureus
• telavancin
• vancomycin
• ventilator-associated pneumonia

Financial & competing interests disclosure

E Nannini has received honoraria from Theravance Inc. and Cerexa, and research grant support from Astellas, Johnson & Johnson and Novartis. MStryjewski has served as a consultant for Trius Therapeutics, Theravance Inc., Nabriva, The Medicines Company, Cerexa, Furiex and PRA International and has received honoraria from Astellas and Cempra. GCorey has served as a consultant and/or received research support from Theravance Inc., Astellas, Cubist Pharmaceuticals, Cerexa, Merck, Pfizer, Cempra Inc., Polymedix, Nabriva, The Medicines Company, GSK, Trius, Durata, PRA International, Furiex, Inimex, Innocoll, Rib-X, Seachaid, Dr Reddy’s Laboratory, Tetraphase, Synereca, AstraZeneca, Achaogen and Furiex. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.