Phase 3 study comparing tigecycline and ertapenem in patients with diabetic foot infections with and without osteomyelitis

A phase 3, randomized, double-blind trial was conducted in subjects with diabetic foot infections without osteomyelitis (primary study) or with osteomyelitis (substudy) to determine the efficacy and safety of parenteral (intravenous [iv]) tigecycline (150 mg once-daily) versus 1 g once-daily iv ertapenem vancomycin. Among 944 subjects in the primary study who received 1 dose of study drug, >85% had type 2 diabetes; similar to 90% had Perfusion, Extent, Depth/tissue loss, Infection, and Sensation infection grade 2 or 3; and similar to 20% reported prior antibiotic failure. For the clinically evaluable population at test-of-cure, 77.5% of tigecycline- and 82.5% of ertapenem +/- vancomycin-treated subjects were cured. Corresponding rates for the clinical modified intent-to-treat population were 71.4% and 77.9%, respectively. Clinical cure rates in the substudy were low (< 36%) for a subset of tigecycline-treated subjects with osteomyelitis. Nausea and vomiting occurred significantly more often after tigecycline treatment (P = 0.003 and P < 0.001, respectively), resulting in significantly higher discontinuation rates in the primary study (nausea P = 0.007, vomiting P < 0.001). In the primary study, tigecycline did not meet criteria for noninferiority compared with ertapenem +/- vancomycin in the treatment of subjects with diabetic foot infections. (C) 2014 Authors. Published by Elsevier Inc. All rights reserved.