Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial.

Details

Serval ID
serval:BIB_E20EA95FD4C2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial.
Journal
The Lancet. Infectious diseases
Author(s)
Guery B., Menichetti F., Anttila V.J., Adomakoh N., Aguado J.M., Bisnauthsing K., Georgopali A., Goldenberg S.D., Karas A., Kazeem G., Longshaw C., Palacios-Fabrega J.A., Cornely O.A., Vehreschild MJGT
Working group(s)
EXTEND Clinical Study Group
ISSN
1474-4457 (Electronic)
ISSN-L
1473-3099
Publication state
Published
Issued date
03/2018
Peer-reviewed
Oui
Volume
18
Number
3
Pages
296-307
Language
english
Notes
Publication types: Clinical Trial, Phase III ; Clinical Trial, Phase IV ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Clostridium difficile infection causes severe complications and frequently recurs. An extended-pulsed fidaxomicin regimen might facilitate sustained clinical cure by prolonging C difficile suppression and supporting gut microbiota recovery. We aimed to compare clinical outcomes of extended-pulsed fidaxomicin with standard vancomycin.
In this randomised, controlled, open-label, superiority study, we recruited hospitalised adults aged 60 years and older with confirmed C difficile infection at 86 European hospitals. Patients were randomly assigned (1:1) using an interactive web response system to receive extended-pulsed fidaxomicin (200 mg oral tablets, twice daily on days 1-5, then once daily on alternate days on days 7-25) or vancomycin (125 mg oral capsules, four times daily on days 1-10), stratified by baseline C difficile infection severity, cancer presence, age (≥75 years vs <75 years), and number of previous C difficile infection occurrences. The primary endpoint was sustained clinical cure 30 days after end of treatment (day 55 for extended-pulsed fidaxomicin and day 40 for vancomycin), assessed in all randomised patients who met the inclusion criteria and received at least one dose of study medication (modified full analysis set). Adverse events were assessed in all patients who received at least one dose of study drug. The study is registered with ClinicalTrials.gov, number NCT02254967.
Between Nov 6, 2014, and May 5, 2016, 364 patients were enrolled and randomly assigned to receive extended-pulsed fidaxomicin or vancomycin. 362 patients received at least one dose of study medication (181 in each group). 124 (70%) of 177 patients in the modified full analysis set receiving extended-pulsed fidaxomicin achieved sustained clinical cure 30 days after end of treatment, compared with 106 (59%) of 179 patients receiving vancomycin (difference 11% [95% CI 1·0-20·7], p=0·030; odds ratio 1·62 [95% CI 1·04-2·54]). Incidence of treatment-emergent adverse events did not differ between extended-pulsed fidaxomicin (121 [67%] of 181) and vancomycin (128 [71%] of 181) treatment arms. One death in the vancomycin arm was considered by the investigator to be related to study drug.
Extended-pulsed fidaxomicin was superior to standard-dose vancomycin for sustained cure of C difficile infection, and, to our knowledge, extended-pulsed fidaxomicin recurrence rates in this study are the lowest observed in a randomised clinical trial of antibiotic treatment for C difficile infection.
Astellas Pharma, Inc.
Keywords
Aged, Aged, 80 and over, Clostridium difficile, Enterocolitis, Pseudomembranous/drug therapy, Female, Fidaxomicin/administration & dosage, Fidaxomicin/therapeutic use, Humans, Male, Middle Aged, Vancomycin/therapeutic use
Pubmed
Web of science
Create date
13/01/2018 12:58
Last modification date
20/08/2019 17:06
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