LEAP Results: Which Antibiotic Works Best Against Multilobar Pneumonia?

The response rates of patients with community-acquired bacterial pneumonia (CABP) were high and similar for lefamulin and moxifloxacin in LEAP 1 and 2 trials, according to data presented at CHEST 2021.

To investigate the efficacy and safety of the pleuromutilin antibiotic lefamulin in patients with CABP who have or may be at risk for severe pneumonia, the researchers analyzed pooled data from the Lefamulin Evaluation Against Pneumonia (LEAP) 1 and 2 trials based on whether infiltrates were unilobar or multilobar.

Researchers analyzed early clinical response 96 hours after the first medication dose and investigator-assessed clinical response at test of cure 5 to 10 days after the last dose in the intent-to-treat population of all randomly assigned patients with at least 1 baseline CABP-causing pathogen. They also assessed treatment-emergent adverse events (TEAEs).

In LEAP 1, adults with CABP received intravenous lefamulin, 150 mg every 12 hours for 5 to 7 days, or moxifloxacin, 400 mg daily for 7 days. In LEAP 2, they received oral lefamulin, 600 mg every 12 hours for 5 days, or moxifloxacin, 400 mg daily for 7 days. 

Patients treated with either antibiotic had high and similar rates of early and late clinical response by disease category. The early response rate against unilobar CABP was 92% for lefamulin vs 94% for moxifloxacin; against multilobar CABP, it was 85% for lefamulin vs. 90% for moxifloxacin. The late response rate against unilobar CABP was 86% for lefamulin vs 89% for moxifloxacin; against multilobar CABP, it was 77% for lefamulin vs 80% for moxifloxacin.

Streptococcus pneumoniae was the most frequently identified baseline pathogen in both treatment groups. Most TEAEs were gastrointestinal, and TEAE rates were similar across treatment and disease groups.

The researchers concluded that lefamulin “is an alternative to fluoroquinolones for treating CABP in patients with multilobar pneumonia who have or may be at risk for severe pneumonia.”

—Ellen Kurek

Reference:

File T, Mariano D, Gelone S, Moran G, Waterer G, Sandrock C. Lefamulin efficacy and safety in adults with community-acquired bacterial pneumonia:  pooled analysis of the Lefamulin Evaluation Against Pneumonia (LEAP) 1 and LEAP 2 trials in patients with multilobar and unilobar pneumonia.  Paper presented at: Chest 2021 Annual Meeting; October 17–20; Virtual.