CANVAS 1 and 2: analysis of clinical response at day 3 in two phase 3 trials of ceftaroline fosamil versus vancomycin plus aztreonam in treatment of acute bacterial skin and skin structure infections

Antimicrob Agents Chemother. 2012 May;56(5):2231-6. doi: 10.1128/AAC.05738-11. Epub 2012 Feb 6.

Abstract

Scientific and regulatory interest in assessing clinical endpoints after 48 to 72 h of treatment for acute bacterial skin and skin structure infections (ABSSSI) has increased. Historical, pre-antibiotic-era data suggest that a treatment effect relative to untreated controls can be discerned in this time interval. Ceftaroline fosamil, a broad-spectrum bactericidal cephalosporin with activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative organisms was efficacious in two phase 3 trials of complicated skin infections (CANVAS 1 and 2) using clinical cure rates at the test-of-cure visit. To assess an early clinical response in the CANVAS trials, a retrospective analysis using a day 3 clinical endpoint was conducted. Adults with ABSSSI received intravenous ceftaroline fosamil at 600 mg every 12 h (q12h) or vancomycin at 1 g plus aztreonam at 1 g (V/A) q12h for 5 to 14 days. Clinical response at day 3, defined as cessation of infection spread and absence of fever, was analyzed in patients with a lesion size of ≥ 75 cm(2) and either deep and/or extensive cellulitis, major abscess, or an infected wound. Day 3 integrated CANVAS clinical response rates were 74.0% (296/400) for ceftaroline and 66.2% (263/397) for V/A (difference, 7.8%; 95% confidence interval [CI], 1.3% to 14.0%). In the individual studies, absolute treatment differences of 9.4% (CANVAS 1) and 5.9% (CANVAS 2) favoring ceftaroline were observed. For ABSSSI due to MRSA, response rates were 81.7% and 77.4% in the ceftaroline and V/A groups, respectively. In this retrospective analysis, ceftaroline fosamil monotherapy had a numerically higher clinical response than V/A at day 3 in the treatment of ABSSSI.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Aztreonam / administration & dosage
  • Aztreonam / therapeutic use*
  • Biomarkers / analysis*
  • Ceftaroline
  • Cephalosporins / administration & dosage
  • Cephalosporins / therapeutic use*
  • Drug Administration Schedule
  • Female
  • Gram-Negative Bacteria / drug effects
  • Gram-Negative Bacteria / physiology
  • Gram-Positive Bacteria / drug effects
  • Gram-Positive Bacteria / physiology
  • Humans
  • Injections, Intravenous
  • Male
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / physiology
  • Middle Aged
  • Retrospective Studies
  • Skin Diseases, Bacterial / drug therapy*
  • Skin Diseases, Bacterial / microbiology
  • Treatment Outcome
  • Vancomycin / administration & dosage
  • Vancomycin / therapeutic use*

Substances

  • Anti-Bacterial Agents
  • Biomarkers
  • Cephalosporins
  • Vancomycin
  • Aztreonam