Dalbavancin for the Treatment of Osteomyelitis in Adult Patients: A Randomized Clinical Trial of Efficacy and Safety

Urania Rappo, Sailaja Puttagunta, Vadym Shevchenko, Alena Shevchenko, Alena Jandourek, Pedro L Gonzalez, Amy Suen, Veronica Mas Casullo, David Melnick, Rosa Miceli, Milan Kovacevic, Gertjan De Bock, Michael W Dunne, Urania Rappo, Sailaja Puttagunta, Vadym Shevchenko, Alena Shevchenko, Alena Jandourek, Pedro L Gonzalez, Amy Suen, Veronica Mas Casullo, David Melnick, Rosa Miceli, Milan Kovacevic, Gertjan De Bock, Michael W Dunne

Abstract

Background: Osteomyelitis is a challenging infection that can involve 4-6 weeks of intravenous (IV) antibiotics. Dalbavancin, approved for acute bacterial skin and skin structure infections, has potent activity against gram-positive pathogens. This study assessed the efficacy and safety of dalbavancin as a 2-dose regimen for osteomyelitis.

Methods: This study was a randomized, open-label, comparator-controlled trial in adults with a first episode of osteomyelitis defined by clinical symptoms, radiologic findings, and elevated C-reactive protein. Patients were randomized 7:1 to dalbavancin (1500 mg IV on days 1 and 8) or standard of care (SOC) for osteomyelitis (oral or IV) per investigator judgment for 4-6 weeks. The primary endpoint was clinical response at day 42, defined as recovery without need for additional antibiotics in the clinically evaluable (CE) population. Clinical response was also assessed at day 21, 6 months, and 1 year.

Results: Eighty patients were randomized to dalbavancin (n = 70) or SOC (n = 10). All had baseline debridement; Staphylococcus aureus was the most common pathogen (60% of patients). Clinical cure at day 42 was seen in 65/67 (97%) and 7/8 (88%) patients in the dalbavancin group and SOC group in the CE population, respectively. Clinical response was similar in the dalbavancin group at day 21 (94%), 6 months, and 1 year (96%). Treatment-emergent adverse events occurred in 10 patients in the dalbavancin group; no patient discontinued treatment due to an adverse event.

Conclusions: A 2-dose regimen of weekly dalbavancin is effective and well tolerated for the treatment of osteomyelitis in adults.

Clinical trials registration: NCT02685033.

Keywords: dalbavancin; gram-positive; osteomyelitis.

Figures

Figure 1.
Figure 1.
Patient disposition. Abbreviations: CE, clinically evaluable; ITT, intent-to-treat; micro-mITT, microbiological mITT; mITT, modified intent-to-treat; SOC, standard of care.
Figure 2.
Figure 2.
Clinical outcomes in the (A) CE and (B) mITT populations. Abbreviations: CE, clinically evaluable; CRP, C-reactive protein; IV, intravenous; mITT, modified intent-to-treat; SOC, standard of care.

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