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- Title
Exebacase in Addition to Standard-of-Care Antibiotics for Staphylococcus aureus Bloodstream Infections and Right-Sided Infective Endocarditis: A Phase 3, Superiority-Design, Placebo-Controlled, Randomized Clinical Trial (DISRUPT).
- Authors
Fowler, Vance G; Das, Anita F; Lipka-Diamond, Joy; Ambler, Jane E; Schuch, Raymond; Pomerantz, Roger; Cassino, Cara; Jáuregui-Peredo, Luis; Moran, Gregory J; Rupp, Mark E; Lachiewicz, Anne M; Kuti, Joseph L; Wise, Robert A; Kaye, Keith S; Zervos, Marcus J; Nichols, W Garrett
- Abstract
Background Novel treatments are needed for Staphylococcus aureus bacteremia, particularly for methicillin-resistant S. aureus (MRSA). Exebacase is a first-in-class antistaphylococcal lysin that is rapidly bactericidal and synergizes with antibiotics. Methods In Direct Lysis of Staph Aureus Resistant Pathogen Trial of Exebacase (DISRUPT), a superiority-design phase 3 study, patients with S. aureus bacteremia/endocarditis were randomly assigned to receive a single dose of intravenous exebacase or placebo in addition to standard-of-care antibiotics. The primary efficacy outcome was clinical response at day 14 in the MRSA population. Results A total of 259 patients were randomized before the study was stopped for futility based on the recommendation of the unblinded Data Safety Monitoring Board. Clinical response rates at day 14 in the MRSA population (n = 97) were 50.0% (exebacase + antibiotics; 32/64) versus 60.6% (antibiotics alone; 20/33) (P =.392). Overall, rates of adverse events were similar across groups. No adverse events of hypersensitivity related to exebacase were reported. Conclusions Exebacase + antibiotics failed to improve clinical response at day 14 in patients with MRSA bacteremia/endocarditis. This result was unexpected based on phase 2 data that established proof-of-concept for exebacase + antibiotics in patients with MRSA bacteremia/endocarditis. In the antibiotics-alone group, the clinical response rate was higher than that seen in phase 2. Heterogeneity within the study population and a relatively small sample size in either the phase 2 or phase 3 studies may have increased the probability of imbalances in the multiple components of day 14 clinical outcome. This study provides lessons for future superiority studies in S. aureus bacteremia/endocarditis. Clinical Trials Registration. NCT04160468
- Subjects
ANTIBIOTICS; COMBINATION drug therapy; STAPHYLOCOCCAL diseases; RESEARCH funding; BACTEREMIA; STATISTICAL sampling; INFECTIVE endocarditis; TREATMENT effectiveness; RANDOMIZED controlled trials; METHICILLIN-resistant staphylococcus aureus; DESCRIPTIVE statistics; DRUG efficacy; COMPARATIVE studies; EVALUATION
- Publication
Clinical Infectious Diseases, 2024, Vol 78, Issue 6, p1473
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciae043