Efficacy and Safety of Telavancin in Clinical Trials A Systematic Review and Meta-Analysis 英文参考文献.docVIP

EfficacyandSafetyofTelavancininClinicalTrials:A SystematicReviewandMeta-Analysis KonstantinosA.Polyzos1,MichaelN.Mavros1,KonstantinosZ.Vardakas1,MarinosC.Makris1, PetrosI.Rafailidis1,2,MatthewE.Falagas1,2,3 * 1Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece, 2Department of Medicine, Henry Dunant Hospital, Athens, Greece, 3Department of Medicine, Tufts UniversitySchoolofMedicine,Boston,Massachusetts,UnitedStatesofAmerica Abstract Introduction:TheepidemiologyandantibioticresistanceofStaphylococcusaureushaveevolved,underscoringtheneedfor novelantibiotics,particularlyagainstmethicillin-resistantS.aureus(MRSA).Telavancinisabactericidallipoglycopeptidewith potentactivityagainstGram-positivepathogens. Objective: To systematically review and synthesize the available evidence from randomized controlled trials (RCTs) evaluatingtelavancininthetreatmentofpatientswithinfectionsduetoGram-positiveorganismswiththemethodologyof meta-analysis. Results:SixRCTscomparingtelavancinwithvancomycinwereincluded;4(2229patients)referredtocomplicatedskinand softtissueinfections(cSSTIs)and2(1503patients)tohospital-acquiredpneumonia(HAP).RegardingcSSTIs,telavancinand vancomycinshowedcomparableefficacyinclinicallyevaluablepatients(oddsratio[OR]=1.10[95%confidenceintervals: 0.82–1.48]).AmongpatientswithMRSAinfection,telavancinshowedhighereradicationrates(OR=1.71[1.08–2.70])anda trendtowardsbetterclinicalresponse(OR=1.55[0.93–2.58]).RegardingHAP,telavancinwasnon-inferiortovancomycinin termsofclinicalresponseintwoPhaseIIIRCTs;mortalityratesforthepooledtrialswerecomparablewithtelavancin(20%) andvancomycin(18.6%).PooleddatafromcSSTIsandHAPstudiesontelavancin10mg/kgindicatedhigherratesofserum creatinine increases (OR=2.22 [1.38–3.57]), serious adverse events (OR=1.53 [1.05–2.24]), and adverse event-related withdrawals(OR=1.49[1.14–1.95])amongtelavancinrecipients. Conclusion: Telavancin might be an alternative to vancomycin in cases of difficult-to-treat MRSA infections. The potent antista