Phase II, randomized, multicenter, double-blind, placebo-controlled trial of a polyclonal anti-Staphylococcus aureus capsular polysaccharide immune globulin in treatment of Staphylococcus aureus bacteremia

Mark Edmund Rupp, H. Preston Holley, Jon Lutz, Peter V. Dicpinigaitis, Christopher W. Woods, Donald P. Levine, Naomi Veney, Vance G. Fowler

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

New treatment modalities are needed for the treatment of infections due to multidrug-resistant Staphylococcus aureus. S. aureus capsular polysaccharide immune globulin (Altastaph) is a polyclonal immune globulin preparation that is being developed as adjunctive therapy for persons with S. aureus infections complicated by bacteremia. In a phase II, multicenter, randomized, double-blind, placebo-controlled trial, 40 subjects with documented S. aureus bacteremia received standard therapy plus either Altastaph at 200 mg/kg of body weight in each of two infusions 24 h apart or placebo. During the 42-day observation period, antibody pharmacokinetics and safety were the primary characteristics studied. Information regarding the resolution of bacteremia and fever was also analyzed. Anti-type-5 and anti-type-8 capsular antibody levels peaked after the second infusion at 550 μg/ml and 419 μg/ml, respectively, and remained above 100 μg/ml at day 28. A total of 316 adverse events were noted in 39 of 40 subjects. Infusion-related adverse events in Altastaph recipients were infrequent and similar to those among recipients of commercial intravenously administered immunoglobulin G products. Five of 21 (23%) subjects in the Altastaph group died, whereas 2 of 18 (11%) subjects in the placebo group died (P = 0.42). Compared to the control patients, the Altastaph recipients had a shorter median time to the resolution of fever (2 days and 7 days, respectively; P = 0.09) and a shorter length of hospital stay (9 days and 14 days, respectively; P = 0.03). However, these findings are exploratory, and there were few differences in the other variables measured. High levels of opsonizing antibodies were maintained for the initial 4 weeks. Although the study was not powered to show efficacy, these preliminary findings and safety profile suggest that Altastaph may be an effective adjunct to antibiotics and warrants further investigation.

Original languageEnglish (US)
Pages (from-to)4249-4254
Number of pages6
JournalAntimicrobial Agents and Chemotherapy
Volume51
Issue number12
DOIs
StatePublished - Dec 1 2007

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Bacteremia
Polysaccharides
Staphylococcus aureus
Immunoglobulins
Placebos
Antibodies
Length of Stay
Fever
Therapeutics
Safety
Infection
altastaph
Pharmacokinetics
Immunoglobulin G
Body Weight
Observation
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Phase II, randomized, multicenter, double-blind, placebo-controlled trial of a polyclonal anti-Staphylococcus aureus capsular polysaccharide immune globulin in treatment of Staphylococcus aureus bacteremia. / Rupp, Mark Edmund; Holley, H. Preston; Lutz, Jon; Dicpinigaitis, Peter V.; Woods, Christopher W.; Levine, Donald P.; Veney, Naomi; Fowler, Vance G.

In: Antimicrobial Agents and Chemotherapy, Vol. 51, No. 12, 01.12.2007, p. 4249-4254.

Research output: Contribution to journalArticle

Rupp, Mark Edmund ; Holley, H. Preston ; Lutz, Jon ; Dicpinigaitis, Peter V. ; Woods, Christopher W. ; Levine, Donald P. ; Veney, Naomi ; Fowler, Vance G. / Phase II, randomized, multicenter, double-blind, placebo-controlled trial of a polyclonal anti-Staphylococcus aureus capsular polysaccharide immune globulin in treatment of Staphylococcus aureus bacteremia. In: Antimicrobial Agents and Chemotherapy. 2007 ; Vol. 51, No. 12. pp. 4249-4254.
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abstract = "New treatment modalities are needed for the treatment of infections due to multidrug-resistant Staphylococcus aureus. S. aureus capsular polysaccharide immune globulin (Altastaph) is a polyclonal immune globulin preparation that is being developed as adjunctive therapy for persons with S. aureus infections complicated by bacteremia. In a phase II, multicenter, randomized, double-blind, placebo-controlled trial, 40 subjects with documented S. aureus bacteremia received standard therapy plus either Altastaph at 200 mg/kg of body weight in each of two infusions 24 h apart or placebo. During the 42-day observation period, antibody pharmacokinetics and safety were the primary characteristics studied. Information regarding the resolution of bacteremia and fever was also analyzed. Anti-type-5 and anti-type-8 capsular antibody levels peaked after the second infusion at 550 μg/ml and 419 μg/ml, respectively, and remained above 100 μg/ml at day 28. A total of 316 adverse events were noted in 39 of 40 subjects. Infusion-related adverse events in Altastaph recipients were infrequent and similar to those among recipients of commercial intravenously administered immunoglobulin G products. Five of 21 (23{\%}) subjects in the Altastaph group died, whereas 2 of 18 (11{\%}) subjects in the placebo group died (P = 0.42). Compared to the control patients, the Altastaph recipients had a shorter median time to the resolution of fever (2 days and 7 days, respectively; P = 0.09) and a shorter length of hospital stay (9 days and 14 days, respectively; P = 0.03). However, these findings are exploratory, and there were few differences in the other variables measured. High levels of opsonizing antibodies were maintained for the initial 4 weeks. Although the study was not powered to show efficacy, these preliminary findings and safety profile suggest that Altastaph may be an effective adjunct to antibiotics and warrants further investigation.",
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AU - Dicpinigaitis, Peter V.

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