title: Multicenter, randomized clinical trial to compare the safety and efficacy of LFF571 and vancomycin for Clostridium difficile infections.
abstract: Clostridium difficile infection causes serious diarrheal disease. Although several drugs are available for treatment, including vancomycin, recurrences remain a problem. LFF571 is a semisynthetic thiopeptide with potency against C. difficile in vitro. In this phase 2 exploratory study, we compared the safety and efficacy (based on a noninferiority analysis) of LFF571 to those of vancomycin used in adults with primary episodes or first recurrences of moderate C. difficile infection. Patients were randomized to receive 200 mg of LFF571 or 125 mg of vancomycin four times daily for 10 days. The primary endpoint was the proportion of clinical cures at the end of therapy in the per-protocol population. Secondary endpoints included clinical cures at the end of therapy in the modified intent-to-treat (mITT) population, the time to diarrhea resolution, and the recurrence rate. Seventy-two patients were randomized, with 46 assigned to receive LFF571. Based on the protocol-specified definition, the rate of clinical cure for LFF571 (90.6%) was noninferior to that of vancomycin (78.3%). The 30-day sustained cure rates for LFF571 and vancomycin were 56.7% and 65.0%, respectively, in the per-protocol population and 58.7% and 60.0%, respectively, in the modified intent-to-treat population. Using toxin-confirmed cases only, the recurrence rates were lower for LFF571 (19% versus 25% for vancomycin in the per-protocol population). LFF571 was generally safe and well tolerated. The incidence of adverse events (AEs) was higher for LFF571 (76.1% versus 69.2% for vancomycin), although more AEs in the vancomycin group were suspected to be related to the study drug (38.5% versus 32.6% for LFF571). One patient receiving LFF571 discontinued the study due to an AE. (This study has been registered at ClinicalTrials.gov under registration no. NCT01232595.).
authors.affiliation: The University of Chicago Medicine, Section of Infectious Diseases and Global Health, Chicago, Illinois, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mullane
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton Regional Laboratory Medicine Program, McMaster University, Department of Pathology and Molecular Medicine, Hamilton, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Lee
authors.affiliation: Infectious Disease Specialists of Atlanta, Decatur, Georgia, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Bressler
authors.affiliation: Idaho Falls Infectious Disease, Idaho Falls, Idaho, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Buitrago
authors.affiliation: Université de Montréal, Département de Microbiologie et d'Infectiologie, Hôpital Maisonneuve-Rosemont, Montréal, Quebec, Canada.
authors.forename: Karl
authors.initials: K
authors.lastname: Weiss
authors.affiliation: Novartis Institutes for BioMedical Research, Infectious Disease Area, East Hanover, New Jersey, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Dabovic
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA.
authors.forename: Jens
authors.initials: J
authors.lastname: Praestgaard
authors.affiliation: Novartis Institutes for BioMedical Research, Infectious Disease Area, Emeryville, California, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Leeds
authors.affiliation: Novartis Institutes for BioMedical Research, Infectious Disease Area, Emeryville, California, USA.
authors.forename: Johanne
authors.initials: J
authors.lastname: Blais
authors.affiliation: Novartis Institutes for BioMedical Research, Infectious Disease Area, Cambridge, Massachusetts, USA peter.pertel@novartis.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Pertel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*; D010456:Peptides, Cyclic
chemical_list: D000900:Anti-Bacterial Agents; D013844:Thiazoles; D014640:Vancomycin; C573298:LFF571; D010456:Peptides, Cyclic