LEAP 2: Lefamulin vs Moxifloxacin for CAP
R.E.B.E.L.EM - By Salim Rezaie - December 02, 2019
"Background: Recently there have been some observed trends in decreasing susceptibility among Strep pneumoniae isolates to antimicrobials used to treat community acquired pneumonia (CAP) (Resistance to oral penicillin and macrolides for Strep pneumoniae & macrolides and fluoroquinolones for Staph aureus). New antibacterials are therefore needed to treat CAP because of growing antibacterial resistance.
Lefamulin is the first pleuromutilin antibiotic approved for intravenous and oral use in humans. Both the intravenous and oral formulations were approved in August 2019 by the US Food and Drug Administration (FDA) to treat CAP. It is active against the most common CAP-causing pathogens, including bacteria resistant to other antimicrobial classes. Lefamulin Evaluation Against Pneumonia 1 (LEAP 1) looked at IV Lefamulin vs IV Moxifloxacin in adult patients with moderate to severe CAP and demonstrated noninferiority in that trial. Given those results, LEAP 2 was performed to compare oral Lefamulin to oral Moxifloxacin in adult patients with moderate to severe CAP.
Author Conclusion: “Among patients with CABP, 5-day oral lefamulin was noninferior to 7-day oral moxifloxacin with respect to early clinical response at 96 hours after first dose.”
Clinical Take Home Point: Both Lefamulin and Moxifloxacin had a high cure rate in the ITT population with CAP, however given the cost of Lefamulin and greater GI side effects compared to Moxifloxacin, unless there is known bacterial resistance, or a good reason to use this antibiotic, the antibiotic to choose is still Moxifloxacin or a penicillin + macrolide for CAP."