Efficacy and safety of oritavancin for the treatment of acute bacterial skin and skin-structure infections: a systematic review and meta-analysis

Objectives: This study aimed to evaluate the efficacy and safety of oritavancin (ORI) versus comparators for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs) based on available clinical studies. Methods: PubMed, Cochrane Library and Embase were searched from database inception to 28 July 2020 to identify clinical studies assessing the efficacy and safety of ORI and comparator antibiotics for the treatment of ABSSSIs. Primary efficacy outcome, investigator-assessed clinical cure, lesion size reduction >= 20%, additional post-treatment antibiotics, and 30-day emergency room (ER) visits and readmission were assessed as efficacy outcomes. Adverse events (AEs) and mortality were assessed as safety outcomes. I-2 statistic was calculated for heterogeneity, and a fixed-effects or random-effects model was used for estimation of the risk ratio (RR). Results: A total of 9213 patients from two randomised clinical trials (RCTs) and four cohort studies were included in this meta-analysis. ORI was statistically non-inferior to control agents in all efficacy and safety outcomes. Moreover, ORI significantly reduced the occurrence of 30-day readmission (RR = 0.42; P = 0.0004) and drug-related AEs (RR = 0.78; P = 0.002). In the subgroup analysis, ORI also had a lower rate of 30-day ER visits in the outpatient setting (RR = 0.34; P < 0.00 001). Conclusion: ORI was not inferior to comparators for the treatment of ABSSSIs. Meanwhile, it showed advantages in reducing the rate of readmission and drug-related AEs. More high-quality and large-scale RCTs are required to further confirm the efficacy and safety of ORI. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.