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Efficacy of fidaxomicin vs vancomycin for C. difficile-associated diarrhoea (CDAD) in pts with cancer Post-hoc analysis of 2 multi-centre, double-blind.

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Presentation on theme: "Efficacy of fidaxomicin vs vancomycin for C. difficile-associated diarrhoea (CDAD) in pts with cancer Post-hoc analysis of 2 multi-centre, double-blind."— Presentation transcript:

1 Efficacy of fidaxomicin vs vancomycin for C. difficile-associated diarrhoea (CDAD) in pts with cancer Post-hoc analysis of 2 multi-centre, double-blind RCTs 1,2 in 1,105 pts with confirmed CDAD and ≤1 prior episode of CDAD in 90 days, treated for 10 days with: –Fidaxomycin (FDX): 200 mg orally 2x/day –Vancomycin (VCA): 125 mg orally 4x/day Subgroup analysis: patients with cancer Cornely OA et al. J Clin Oncol 2013;31:2493-9 1 of 2

2 Efficacy of fidaxomicin vs vancomycin for C. difficile-associated diarrhoea (CDAD) in pts with cancer In cancer pts, FDX may be superior to VCA for Tx of CDAD, given its shorter TTROD, fewer recurrences and sustained response rate Cornely OA et al. J Clin Oncol 2013;31:2493-9 2 of 2

3 New assay for predicting cytomegalovirus (CMV) disease in solid-organ transplant (SOT) recipients: diagnostic accuracy Multi-centre, longitudinal study (2008-2011) : N=127 SOT recipients with pretransplant donor CMV-seropositive, recipient-seronegative (D + /R - ) status, scheduled for antiviral prophylaxis for 3-6 mo (ganciclovir or valganciclovir) Measurement of CMV-specific cell-mediated immunity: –Quantiferon-CMV assay: measures interferon-γ following in vitro stimulation with CMV antigens (3x 1 ml aliquot of whole blood needed/assay) –At 3 time points: 1.At prophylaxis discontinuation (3-6 mo after transplantation (TP)) 2.1 mo after prophylaxis discontinuation 3.2 mo after prophylaxis discontinuation Median duration of antiviral prophylaxis: 98 days Primary endpoint: Incidence of CMV disease within 12 mo after TP: 28/127 pts (22%), at median time of 209 days after TP Manuel O et al. Clin Infect Dis 2013;56:817-24 1 of 2

4 New assay for predicting cytomegalovirus (CMV) disease in solid-organ transplant (SOT) recipients: diagnostic accuracy The Quantiferon-CMV assay may be useful in D + /R - SOT recipients to predict the risk of developing CMV disease after prophylaxis Manuel O et al. Clin Infect Dis 2013;56:817-24 2 of 2

5 Multi-centre, double-blind, dose-escalating RCT (2009-2011): N=230 adult cytomegalovirus (CMV)-seropositive pts who had undergone allogeneic haematopoietic-cell transplantation Tx: oral CMX001 or placebo: start at 14-30 days after transplantation/ duration for 9-11 wk/ stop at wk 13 after transplantation Pts with CMV disease or CMV DNA at a level requiring Tx discontinued study drug and received preemptive Tx against CMV Primary endpoint: CMV event = CMV disease or plasma CMV DNA level >200 copies/ml within 1 wk after last CMX001 dose Efficacy and safety of CMX001 for the prevention of CMV in haematopoietic-cell transplantation pts Marty FM et al. N Engl J Med 2013;369:1227-36 1 of 2

6 Diarrhoea: one of most common AEs if CMX001 dose ≥200 mg/wk No evidence of myelosuppresion or nephrotoxicity Efficacy and safety of CMX001 for the prevention of CMV in haematopoietic-cell transplantation pts Oral CMX001 at a dose of 100 mg 2x/wk may significantly reduce the incidence of CMV events in haematopoietic-cell transplant recipients Marty FM et al. N Engl J Med 2013;369:1227-36 2 of 2

7 Single-centre longitudinal study (USA; 2009-2011) : N=94 allo-HSCT pts Serial collection of 3-8 faecal specimens/patient (total: 439 specimens): Type of antibiotics during hospitalisation for allo-HSCT: During allo-HSCT: –Microbial diversity ↓: –Frequent intestinal domination, i.e. occupation of ≥30% of microbiota by a single predominating bacterial taxon (Enterococcus, Streptococcus, Proteobacteria) Impact of allogeneic haematopoietic stem cell transplantation (allo-HSCT) on intestinal microbiota and risk of bloodstream infections (BSIs) Taur Y et al. Clin Infect Dis 2012;55:905-14 1 of 2

8 Impact of allogeneic haematopoietic stem cell transplantation (allo-HSCT) on intestinal microbiota and risk of bloodstream infections (BSIs) Clinical predictors of intestinal domination (increased/decreased risk): Intestinal domination is a predictor of BSI (increased/decreased risk of BSI) : 11/22 pts (50%) with BSIs had preceding intestinal domination: Median time between intestinal domination and BSI: 7 days Treatment during/after allo-HSCT may disrupt intestinal flora diversity, with domination by a single taxon, predicting subsequent BSIs Taur Y et al. Clin Infect Dis 2012;55:905-14 2 of 2

9 Risk of progressive multifocal leukoencephalopathy (PML) in multiple sclerosis (MS) pts treated with natalizumab (NTZ) Data from postmarketing data from Biogen Idec global safety database, clinical studies (TYGRIS, AFFIRM, STRATIFY-1) and an independent Swedish registry of MS pts: N=99,571 MS pts treated (Tx) with NTZ Blood samples available for testing on antibodies (Abs) against anti-John Cunningham virus (JCV): N=5,896 pts, including 54 pts who developed PML Overall incidence of PML: N=212 → 2.1 cases/1,000 pts Estimated PML incidence/1,000 pts (95% CI) Positive anti-JCV Ab status, prior use of IS and increasing duration of NTZ treatment, alone or in combination, are risk factors for PML in MS pts treated with NTZ Bloomgren C et al. N Engl J Med 2012;366:1870-80


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