학술논문
FOCUS 2: a randomized, double-blinded, multicentre, Phase III trial of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia
Document Type
Academic Journal
Author
Low, Donald E.; File, Thomas M., Jr; Eckburg, Paul B.; Talbot, George H.; David Friedland, H.; Lee, Jon; Llorens, Lily; Critchley, Ian A.; Thye, Dirk A.; Corral, Jorge; Giugno, Eduardo; Gonzalez Arzac, Maria del Rosario; Maurizi, Diego; Altclas, Javier; Ambasch, Germán; Jasovich, Abel; Minguez, Angel Ramon; Oliva, Maria Eugenia; Teglia, Osvaldo; Bergallo, Carlos; Mastruzzo, Maria Antonia; Isabel Morera, Graciana; Scapellato, Pabio Gustavo; Lamberghini, Ricardo; Mykietiuk, Analia; Remolif, Christian; Barros Monge, Manuel Jose; Enriqueta Campos Barker, Maria Isabel; Chernilo Steinmann, Sara Mireya; Gaete Gutierrez, Pablo Antonio; Muñoz Vejar, Sylvia Susana; Calvo Arellano, Mario Andres; Chahin Anania, Carolina Eugenia; Jauregui Cruz, Arturo; Amaya Tapia, Gerardo; Acuna Kaldman, Moises; Noriega, Eduardo; Matos Prado, Eduardo Demetrio; Ramos, Carlos; Andreeva, Irina; Abyshev, Rashad; Antonovsky, Yuri A.; Balyuzek, Marina; Esina, Alla L.; Gorelov, Alexander; Khrustalev, Oleg A.; Kozlov, Roman S.; Novozhenok, Vladislav; Popova, Veronika B.; Sobchenko, Svetlana; Trofimov, Vasily; Yakovlev, Sergey; Zhidkov, Konstantin; Ambert, Luminta Gabriela; Fierbinteau, Carmen Georgeta; Ionescu, Valentina; Muresan, Mihai Marius; Tanaseanu, Cristina Mihaela; Georgiev, Ognian; Hodzhev, Valdimir; Marinov, Rosen; Metev, Hristo; Peneva, Marinka; Popov, Dimitar; Simeonova, Milkana; Krastins, Ivars; Lovcinovsk, Viktors; Silins, Viesturs; Svarcberga, Vita; Bargon, Joachim; Bauer, Thorsten; Bergmann, Rolf; Meyer, F.J.; Mueller, Thomas; Welte, Tobias; Glaeser, Sven; Hammerl, Peter; Kern, Hartmut; Krueger, Stefan; Kujath, Peter; Lies, Achim; Schaberg, Tom; Schmalz, Oliver; Schütte, Wolfgang; Chazan, Ryszarda; Górecka, Dorota; Rogala, Barbara; Antczak, Adam; Grodzicki, Tomasz; JahnzRö, Karina; Milanowski, Janusz; Nalepa, Piotr; Wróbel-Rajzer, Malgorzata; Szelerska-Twardosz, Hanna; GrzelewskaRzymowska, Iwona; Kachel, Tomasz; Marciniak, Andrzej; Panaszek, Bernard; Szczeklik, Andrzej; Kozielski, Jerzy; Harat, Rafal; Jastrzebsk, Dariusz; Juszczak, Jacek; Labij, Violetta; Vetter, Norbert; Bolitschek, Josef; Eckmayr, Josef; Molnár, Sándor; Pápai-Székely, Zsolt; Szegedi, Janos; Vinkler, Ilona; Borscchivskyy, Mykhaylo; Dziublyk, Oleksandr; Dzyak, Georgiy V.; Kraydaschenko, Oleg; Mostovoy, Yuriy M.; Rudyk, Iurii S.; Sushko, Viktor; Vizir, Vadim; Bhattacharya, Amal Kumar; Chakrapan, Mahabala; DʼSouza, George; Malpani, G.S.; Mehta, Parthiv; Rao, K.N. Mohar; Talwar, Deepak
Source
Journal of Antimicrobial Chemotherapy. Apr 01, 2011 66(suppl_3 Suppl 3):iii33-iii44
Subject
Language
English
ISSN
0305-7453
Abstract
OBJECTIVES: Ceftaroline (active form of the prodrug ceftaroline fosamil) is a novel cephalosporin with activity against pathogens commonly associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and Gram-negative pathogens. This randomized, double-blind, Phase III study evaluated the efficacy and safety of ceftaroline fosamil in treating patients with CAP. The primary objective was to determine non-inferiority [lower limit of 95% confidence interval (CI) ≥ −10%] of clinical cure rates achieved with ceftaroline fosamil compared with those achieved with ceftriaxone in the clinically evaluable (CE) and modified intent-to-treat efficacy (MITTE) populations. METHODS: Patients hospitalized in a non-intensive care unit setting with CAP of Pneumonia Outcomes Research Team (PORT) risk class III or IV requiring intravenous (iv) therapy were randomized (1:1) to receive 600 mg of ceftaroline fosamil iv every 12 h or 1 g of ceftriaxone iv every 24 h. Clinical cure, microbiological response, adverse events (AEs) and laboratory tests were assessed. FOCUS 2 registration number NCT00509106 (http://clinicaltrials.gov/ct2/show/NCT00509106). RESULTS: The study enrolled 627 patients, 315 of whom received ceftaroline fosamil and 307 of whom received ceftriaxone. Patients in both treatment groups had comparable baseline characteristics. Clinical cure rates were as follows: CE population, 82.1% (193/235) for ceftaroline fosamil and 77.2% (166/215) for ceftriaxone [difference (95% CI), 4.9% (−2.5, 12.5)]; and MITTE population, 81.3% (235/289) for ceftaroline fosamil and 75.5% (206/273) for ceftriaxone [difference (95% CI), 5.9% (−1.0, 12.7)]. Clinical cure rates for CAP caused by S. pneumoniae in the microbiological MITTE (mMITTE) population were 83.3% (35/42) and 70.0% (28/40) for ceftaroline fosamil and ceftriaxone, respectively. Ceftaroline fosamil and ceftriaxone were well tolerated, with similar rates of AEs, serious AEs, deaths and discontinuations due to an AE. The most common AEs for ceftaroline fosamil-treated patients were diarrhoea, headache, hypokalaemia, insomnia and phlebitis, and the most common AEs for ceftriaxone-treated patients were diarrhoea, insomnia, phlebitis and hypertension. CONCLUSIONS: Ceftaroline fosamil achieved high clinical cure and microbiological response rates in patients hospitalized with CAP of PORT risk class III or IV. Ceftaroline fosamil was well tolerated, with a safety profile that is similar to that of ceftriaxone and other cephalosporins. Ceftaroline fosamil is a promising agent for the treatment of CAP.