Study Provides Real-World Support for Single-Dose Oritavancin For ABSSSIs

A retrospective analysis of patient data from 2016 has implicated single-dose oritavancin as an alternative to multidose vancomycin in the treatment of acute bacterial skin and skin structure infections (ABSSSIs). If the data presented as a poster at ID Week 2018 hold in prospective studies, then the use of the novel semisynthetic glycopeptides antibiotic with activity against gram-positive bacteria could usher in an era when the treatment of ABSSSIs would not require an extended hospital stay.

Many patients with ABSSSIs might be effectively and safely treated as an outpatient. This would spare them hospitalization, lessen their chances of acquiring a nosocomial infection, and would exact cost savings for health care systems. The data from 2 phase 3 trials^1,2 indicated the comparable efficacy and safety of oritavancin delivered once intravenously and vancomycin delivered intravenously twice daily for 7-10 days.

The results are cause for optimism. But, evidence that the clinical trial findings extend to the real world would provide even more support for the single injection strategy of oritavancin as a plausible alternative for the current vancomycin regimen.

As a response, this study took a retrospective look at patient data in 2 Truven Health Marketscan Databases. The data used were from patients covered by private health care plans from large companies and other patients covered by Medicare.

The 30-day hospital admission rates and health care costs among patients with ABSSSIs who received oritavancin (n = 120) or vancomycin (n = 6695) on an outpatient basis were compared.

Patients in both groups were comparable at baseline for a raft of demographic and pre-clinical characteristics, as well as their prior antibiotic therapies, type and site of the skin infections, severity of the infections, and prior use of health care (hospitalization, emergency room visit, and outpatient care as three example factors), and health care costs.

A multivariate analysis revealed that patients who received single-dose oritavancin were significantly less likely to be hospitalized, compared to those who received multidose vancomycin (5.8% vs 16.2%; P = .002). The mean ± standard deviation 30-day cost of treatment between the oritavancin and vancomycin patient groups was $10,096 ± $8865 vs $12,779 ± $28,773; P = .3.

The study was limited by the lack of data on comorbid conditions, possibility of inaccurately entered data, and the variation in the determination of health care costs between health care plans.

Randomized prospective studies that involve a larger number of oritavancin-treated patients will be needed to validate these findings, to explore the reasons for the lack of cost savings of the single-dose regimen, and to clarify patient outcomes. But, for now, the results bolster the rationale for single-dose oritavancin as an alternative to multi-dose vancomycin for the treatment of ABSSSI.

The individuals included in the analyses were >18 years of age, had been eligible for medical and pharmacy benefits for at least the previous 180 days, had received their prescription for medication in the outpatient setting, and had not been hospitalized for the 3 days prior to treatment.

The poster was presented by Thomas Lodise, PharmD, PHD, Albany College of Pharmacy, Albany, New York. The research was funded by Melinta Therapeutics.

REFERENCES:

1. Corey GR, Kabler H, Mehra P, et al. Single-Dose Oritavancin in the Treatment of Acute Bacterial Skin Infections. N Engl J Med. 2015;3770:2180-2190. doi: 10.1056/NEJMoa1310422.
2. Corey GR, Good S, Jiang H, et al. Single-dose oritavancin versus 7-10 days of vancomycin in the treatment of gram-positive acute bacterial skin and skin structure infections: the SOLO II noninferiority study. Clin Infect Dis 2015;60:254-26 doi: 10.1093/cid/ciu778.

DISCLOSURES

Roy Chemaly, MD, MPH: Chimerix Inc, grants, and personal fees; Merck & Co Inc, grants, and personal fees; Novartis, grant; Astellas, personal fees; Oxford Immunotec, personal fees.

Jonathan Schelfhout, PhD: Merck & Co Inc, employee.

PRESENTATIONS

Poster Session: Infectious Diseases

Roy F. Chemaly, MD

MD Anderson Cancer Center

Poster 542. Clinical & Economic Burden of Pre-Emptive Therapy (PET) of Cytomegalovirus (CMV) Infection in Hospitalized Allogeneic Hematopoietic Cell Transplant (allo-HCT) Recipients: The MD Anderson Cancer Center Experience

Brian Hoyle, PhD, is a medical and science writer and editor from Halifax, Nova Scotia, Canada. He has been a full-time freelance writer/editor for over 15 years. Prior to that, he was a research microbiologist and lab manager of a provincial government water testing lab. He can be reached at hoyle@square-rainbow.com.