Patient Disposition, Demographic, and Baseline Characteristics
A total of 105 patients, 32 cSSSI (21 TLV and 11 VAN) and 73 HABP/VABP (35 TLV and 38 VAN) patients from the ATLAS and ATTAIN studies, respectively, had concurrent SAB. Baseline and demographic variables were comparable for both treatment groups within each infection type (Table
1). Patients aged ≥65 years accounted for approximately 31% of the cSSSI and 55% of the HABP/VABP groups. For both cSSSI and HABP/VABP groups with concurrent bacteremia, common comorbidities included diabetes and hypertension. The baseline pathogens isolated for each infection are also listed in Table
1. Impaired renal function (CrCl levels ≤50 mL/min) was observed at baseline in 20% and 31% of patients with cSSSI and HABP/VABP, respectively. Approximately equal numbers of patients with HABP/VABP and concurrent SAB were ventilated at baseline in the TLV (
n = 18, 51%) compared with VAN (
n = 19, 50%) groups. In cSSSI patients with concurrent bacteremia, the
S. aureus (MRSA and MSSA) minimum inhibitory concentration for 50% or 90% of isolates (MIC
50, MIC
90) were 0.06 μg/mL for TLV and 1 μg/mL for VAN, respectively. Among HABP/VABP patients with bacteremia, the MSSA MIC
50 and MIC
90 values were 0.03 and 0.06 μg/mL for TLV, respectively, and 1 μg/mL for VAN; the MRSA MIC
50 and MIC
90 values were 0.06 and 0.12 μg/mL for TLV, respectively, and 1 μg/mL for VAN.
Table 1
Baseline and demographic characteristics
Age |
Mean years ± SD | 52 ± 16.9 | 52 ± 19.4 | 65 ± 20.1 | 61 ± 17.6 |
<65 years, n (%) | 15 (71) | 7 (64) | 13 (37) | 20 (53) |
≥65 years, n (%) | 6 (29) | 4 (36) | 22 (63) | 18 (47) |
Race, n (%) |
White | 16 (76) | 8 (73) | 25 (71) | 26 (68) |
African American | 3 (14) | 3 (27) | 2 (6) | 2 (5) |
Asian | 2 (10) | 0 (0) | 8 (23) | 7 (18) |
American Indian or Alaskan native | 0 (0) | 0 (0) | 0 (0) | 3 (8) |
Weight, mean kg ± SD | 75 ± 15.7 | 73 ± 15.6 | 73 ± 16.3 | 72 ± 18.6 |
Body mass index, mean kg/m2 ± SD | 26 ± 4.4 | 26 ± 5.0 | 26 ± 5.4 | 25 ± 5.7 |
S. aureus, n (%) |
Infection site, MSSA | 6 (29) | 4 (36) | 12 (34) | 10 (26) |
Infection site, MRSA | 11 (52) | 5 (4) | 17 (49) | 24 (63) |
Blood, MSSA | 8 (38) | 7 (64) | 14 (40) | 14 (37) |
Blood, MRSA | 13 (62) | 4 (36) | 21 (60) | 24 (63) |
Baseline renal function (CrCl mL/min), n (%) |
>80 | 11 (55) | 4 (40) | 15 (43) | 14 (42) |
>50–80 | 6 (30) | 3 (30) | 11 (31) | 7 (21) |
30–50 | 3 (15) | 2 (20) | 6 (17) | 7 (21) |
<30 | 0 (0) | 1 (10) | 3 (9) | 5 (15) |
Diabetes, n (%) | 6 (29) | 3 (27) | 6 (17) | 10 (26) |
Hypertension, n (%) | 9 (43) | 5 (45) | 20 (57) | 18 (47) |
Efficacy Outcomes
Telavancin-treated patients with cSSSI and concurrent SAB received their study drug for a mean of 10 days (median of 8 days, range of 1–15 days), and VAN-treated patients received their study drug for a mean of 9 days (median of 10 days, range of 2–15 days). Overall, 21 (66%) cSSSI bacteremic patients (13 TLV and 8 VAN) completed the course of study drug therapy and had resolution of signs and symptoms in ≤14 days. A total of 11 (8 TLV and 3 VAN) patients discontinued treatment, with unsatisfactory therapeutic response being the most common reason for drug discontinuation. Overall clinical cure rates were similar between TLV-treated patients (12/21, 57.1%) and VAN-treated patients (6/11, 54.5%) [difference: −0.8% (95% CI −34.4%, 35.5%)] (Table
2). Eight patients (7 TLV, 1 VAN) had a clinical response “not cured,” 2 patients (1 TLV, 1 VAN) had an indeterminate response, and 4 (1 TLV, 3 VAN) had a missing response at TOC. Treatment failure was most commonly attributed to drug discontinuation due to unsatisfactory therapeutic response. One VAN-treated patient with concurrent bacteremia died in the cSSSI studies. The patient presented with cellulitis at the peripheral intravenous infusion site at baseline, developed hypoxemia due to pulmonary edema, and ultimately died of septic shock.
Table 2
Clinical cure rates at test-of-cure in patients with bacteremia in ATLAS and ATTAIN trials
S. aureus
| 12/21 (57.1) | 6/11 (54.5) | −0.8 (−34.4, 35.5)b
| 19/35 (54.3) | 18/38 (47.4) | 9.9 (−13.9, 33.6) |
MSSA | 4/8 (50.0) | 4/7 (57.1) | −6.0 (−48.4, 40.4)b
| 8/14 (57.1) | 9/14 (64.3) | −6.5 (−39.7, 29.8)b
|
MRSA | 8/13 (61.5) | 2/4 (50.0) | −0.5 (−44.3, 52.2)b
| 11/21 (52.4) | 9/24 (37.5) | 17.7 (−12.8, 42.3)b
|
Three cSSSI patients had concurrent bacteremia (2 MSSA and 1 MRSA) that persisted for 3, 4, and 6 days past the baseline blood culture, respectively. Two were treated with VAN, and 1 was treated with TLV. The TLV-treated patient was also diagnosed with infective endocarditis and vertebral osteomyelitis. All 3 patients with persistent bacteremia were considered treatment failures.
Telavancin-treated patients with HABP/VABP and concurrent SAB received the study drug for a mean of 11 days (median of 11, range of 2–22 days), and VAN-treated patients received the study drug for a mean of 9 days (median of 9, range of 1–23 days). Overall, 38 (52%) HABP/VABP patients with SAB (19 TLV and 19 VAN) completed the course of study drug therapy and had resolution of signs and symptoms in ≤21 days. A total of 35 (16 TLV and 19 VAN) patients discontinued treatment with unsatisfactory therapeutic response being the most common reason for drug discontinuation. The overall clinical cure rates for the TLV (54.3%) and VAN (47.4%) groups were comparable (difference of 9.9% [95% CI −13.9%, 33.6%]) (Table
2). Twelve patients (4 TLV, 8 VAN) had a clinical response “failure,” 5 patients (2 TLV, 3 VAN) had an indeterminate response, and 19 (10 TLV, 9 VAN) had a missing response at TOC. Treatment failure was most commonly attributed to progression of pneumonia. In total, 29 deaths were reported in the HABP/VABP bacteremic patients; the 28-day, all-cause mortality rate was comparable in the 2 treatment groups (TLV 14/35 [40.0%] and VAN 15/38 [39.5%]).
In the HABP/VABP studies, 4 patients had bacteremia that persisted beyond baseline in the TLV group (1 MSSA and 3 MRSA). Two of the 4 patients were cured after 3 and 4 days of positive blood cultures, respectively. The other 2 patients died; 1 due to septic shock after 7 days of persistent positive blood cultures for MRSA, and the other patient had care withdrawn after 5 days of persistent positive blood cultures. Eight VAN-treated patients had persistent bacteremia (2 MSSA and 6 MRSA). One of these patients, with 3 days of blood cultures positive for MRSA, was cured. Five of the other 7 patients died, all following 3–4 days of persistent positive blood cultures. The remaining 2 patients, who were bacteremic for 6 and 7 days, respectively, were successfully treated with linezolid or a combination of cloxacillin and clindamycin, respectively.
Safety Analysis
For the cSSSI patients, no notable difference was observed between the treatment groups in the incidences of AEs, SAEs, or AEs leading to discontinuation of study drug. A total of 2 (6%) cSSSI patients with concurrent SAB (TLV 1/21 and VAN 1/11) discontinued study medication due to AEs. Common AEs, such as dysgeusia, headache, vomiting, and foamy urine, were reported more often in the TLV group (Table
3). There was a single report each of renal impairment and renal insufficiency. These MedDRA-defined AEs were reported by the investigators based on their clinical judgment. No renal AEs were reported in the VAN treatment group.
Table 3
Common adverse events (≥10%)
Blood and lymphatic system disorders |
Anemia | 2 (10) | 0 (0) | 5 (14) | 4 (11) |
Cardiac disorders |
Atrial fibrillation | 2 (10) | 0 (0) | 1 (3) | 2 (5) |
Gastrointestinal disorders |
Abdominal pain | 2 (10) | 1 (9) | 1 (3) | 0 (0) |
Constipation | 3 (14) | 1 (9) | 4 (11) | 3 (8) |
Diarrhea | 4 (19) | 1 (9) | 3 (9) | 3 (8) |
Nausea | 7 (33) | 4 (36) | 6 (17) | 1 (3) |
Vomiting | 4 (19) | 1 (9) | 5 (14) | 0 (0) |
General disorders and administration site conditions |
Edema peripheral | 1 (5) | 1 (9) | 4 (11) | 3 (8) |
Infections and infestations |
Pneumonia | 1 (5) | 0 (0) | 1 (3) | 4 (11) |
Septic shock | 0 (0) | 1 (9) | 4 (11) | 5 (13) |
Metabolism and nutrition disorders |
Hypokalemia | 1 (5) | 0 (0) | 5 (14) | 4 (11) |
Hypomagnesemia | 1 (5) | 2 (18) | 1 (3) | 2 (5) |
Nervous system disorders |
Dysgeusia | 7 (33) | 1 (9) | – | – |
Headache | 6 (29) | 3 (27) | 0 (0) | 1 (3) |
Psychiatric disorders |
Agitation | 2 (10) | 0 (0) | 2 (6) | 2 (5) |
Anxiety | 2 (10) | 0 (0) | 1 (3) | 1 (3) |
Insomnia | 4 (19) | 1 (9) | – | – |
Renal and urinary disorders |
Foamy urinea
| 4 (19) | 0 (0) | – | – |
Respiratory, thoracic, and mediastinal disorders |
Dyspnea | 2 (10) | 0 (0) | – | – |
Pulmonary edema | 0 (0) | 2 (18) | – | – |
Skin and subcutaneous tissue disorders |
Pruritus | 1 (5) | 2 (18) | 0 (0) | 1 (3) |
Pruritus generalized | 1 (5) | 2 (18) | – | – |
Vascular disorders |
Hypotension | 0 (0) | 2 (18) | 2 (6) | 4 (11) |
The frequencies and types of AEs, SAEs, and AEs leading to discontinuation of the study drug were comparable between treatment groups for HABP/VABP patients with concurrent SAB. A total of 7 (10%) bacteremic patients (TLV 2/35 and VAN 5/38) discontinued the study drug due to AEs. Anemia, septic shock, and hypokalemia were the most commonly reported AEs by the HABP/VABP bacteremic patients in both treatment groups (Table
3). The incidence of renal AEs was less than 10% across both treatments in HABP/VABP patients with concurrent SAB (TLV, 2 renal impairment and 1 renal insufficiency; VAN, 2 acute renal failure, 1 renal insufficiency, and 1 nephrotic syndrome).