Abstract
Introduction: Four inhaled antibiotics (IABs) are approved in Europe for treatment of chronic P. aeruginosa (PA) lung infection in cystic fibrosis (CF).
Aims and Objective: A systematic literature review (SLR) and Bayesian network meta-analysis (NMA) was conducted to compare the efficacy and safety of levofloxacin inhaled solution (LIS) with other IABs.
Methods: The SLR included all RCTs comparing IABs (tobramycin solution [TIS] and powder [TIP], colistimethate, aztreonam [AZT], and LIS) with ≥4w or ≥24w follow-up. Outcomes included relative and absolute changes in FEV1 % predicted, change in PA density, CFQ-R, respiratory symptoms score, additional antibiotics use, hospitalization, and withdrawal.
Results: 922 articles were identified, and 9 and 7 studies were included in the 4w and 24w NMA, respectively. At 4w, LIS was similar to colistimethate, TIS and TIP; only AZT was better than LIS in relative change in FEV1 % from baseline. All these treatments were comparable. At 24w, none of these treatments were better than LIS with mean relative change in FEV1 % from baseline (95% confidence interval [CI]) of -0.55 (-3.9, 2.8) vs. TIS, -0.57 (-3.9, 2.8) vs. colistimethate, -2.35 (-7.3, 2.6) vs. AZT, and -2.95 (-10.4, 4.5) vs. TIP. Odds ratios (ORs) for hospitalization were numerically higher for TIS (1.70 [0.93, 2.86]) and TIP (2.78 [1.18, 5.63]) compared with LIS. PA density scores, OR for additional antibiotics, and withdrawals due to AEs were comparable between LIS and each IAB at 4w and 24w.
Conclusions: LIS has similar efficacy to available IABs for the treatment of chronic Pseudomonas infection in patients with CF.
- Copyright ©the authors 2016
