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Head-to-head comparison of multi-dose oritavancin and dalbavancin for complicated infections: A propensity
Taylor D Steuber1, Hannah Gipson2, Brian Boyett2
1University of Missouri-Kansas City School of Pharmacy, Columbia, MO.
Background:
Oritavancin and dalbavancin are long-acting lipoglycopeptide antibiotics approved for the treatment of skin and skin structure infections. Recently, they have been used for outpatient antimicrobial therapy for complicated infections. No head-to-head studies exist for this purpose.
Objective:
To compare outcomes of patients treated with multiple doses of oritavancin or dalbavancin for complicated infections.
Patients And Methods:
This was a single-centre, retrospective cohort study evaluating adult patients who received two or more doses of lipoglycopeptides for complicated infections from February 2019 through December 2022. Patients receiving oritavancin were compared to dalbavancin after propensity score-matching. The primary endpoint was clinical success at 90 days. Other endpoints included: 30-day re-admission, 30-day mortality, adverse drug reactions (ADRs), and changes in white blood cell count and inflammatory markers after the first dose.
Results:
After exclusions and propensity score-matching, 131 matched pairs (N = 262) were included in the analysis. Most patients were receiving lipoglycopeptide therapy for osteomyelitis. There was no significant difference in clinical success at 90 days in patients who received oritavancin compared to those who received dalbavancin (99 [76%] vs. 103 [79%], respectively; P = 0.556). There was no significant difference in secondary endpoints, however, there was a trend towards higher incidence of ADRs oritavancin compared to dalbavancin (9 [7%] vs. 2 [2%], respectively; P = 0.060) which led to more treatment discontinuation.
Conclusion:
There was no significant difference in efficacy between multi-dose oritavancin and dalbavancin for the treatment of complicated infections. Both agents were generally well tolerated; however, dalbavancin may be better tolerated when long-term treatment is warranted.
Insights
This study found no significant difference in efficacy between multi-dose oritavancin and dalbavancin for complicated infections. Dalbavancin may offer better tolerability for long-term treatment, with fewer adverse drug reactions observed.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Oritavancin and dalbavancin are long-acting lipoglycopeptides used for skin infections.
- Their use in outpatient parenteral antimicrobial therapy for complicated infections is increasing.
- No direct comparative studies existed for this application.
Purpose of the Study:
- To compare the clinical outcomes of oritavancin versus dalbavancin in patients receiving multiple doses for complicated infections.
- To evaluate secondary endpoints including re-admission, mortality, and adverse drug reactions.
Main Methods:
- A retrospective, single-center cohort study of adult patients receiving two or more doses of lipoglycopeptides.
- Propensity score-matching was used to compare oritavancin and dalbavancin groups.
- Primary endpoint was 90-day clinical success; secondary endpoints included 30-day re-admission, mortality, and adverse drug reactions.
Main Results:
- 131 matched pairs (N=262) were analyzed, primarily for osteomyelitis treatment.
- No significant difference in 90-day clinical success rates between oritavancin (76%) and dalbavancin (79%) (P=0.556).
- A trend towards higher adverse drug reactions with oritavancin (7%) versus dalbavancin (2%) was noted, leading to more discontinuations.
Conclusions:
- Multi-dose oritavancin and dalbavancin demonstrate comparable efficacy for complicated infections.
- Both antibiotics are generally well-tolerated.
- Dalbavancin may be preferred for long-term therapy due to potentially better tolerability.
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