SEATTLE — Elderly patients with community-acquired pneumonia who took moxifloxacin were more likely to have symptom relief by day 3–5 of therapy than were those who took levofloxacin, results from a prospective trial have found.
Investigators observed trends that favored moxifloxacin (Avelox) over levofloxacin (Levaquin) in severely ill patients and those aged 75 years and older, but all other efficacy and safety comparisons between the two agents were similar, Michael Niederman, M.D., commented at the annual meeting of the American College of Chest Physicians.
“The safety and efficacy of both of these drugs was demonstrated and shown to be equivalent,” he said in a later interview.
Dr. Niederman and his associates studied 281 patients aged 65 years and older who were hospitalized with community-acquired pneumonia and required initial IV therapy.
Most patients had multiple comorbidities, especially cardiac disease (74%), chronic obstructive pulmonary disease (63%), and diabetes (29%). Also, 18% had severe pneumonia as defined by American Thoracic Society criteria. Slightly more than half of the patients (51%) were male, and their mean age was 78 years, said Dr. Niederman of Winthrop University Hospital, Mineola, N.Y.
At baseline, all patients had a 12-lead electrocardiogram and a repeat ECG at 72 hours. In the interim, they had a 72-hour period of Holter monitoring.
Of the total group, 141 patients were randomized to moxifloxacin 400 mg/day, and 140 received levofloxacin 500 mg/day. Nearly all patients (98%) in the moxifloxacin group had symptom relief by day 3–5 of therapy, compared with 90% of patients in the levofloxacin group.
Overall cure rates were similar between the moxifloxacin group and the levofloxacin group (93% vs. 88%). The cure rates among patients with mild to moderate pneumonia at baseline were also similar (93% vs. 89%).
The cure rates among patients with severe pneumonia were 95% in the moxifloxacin group, compared with 85% in the levofloxacin group—a difference that trended toward statistical significance, Dr. Niederman said.
Cure rates among patients aged 75 years and older were higher in the moxifloxacin group, compared with those in the levofloxacin group (95% vs. 90%), but the difference was not statistically significant.
Cardiac events considered by the investigators as potentially drug-related were reported in 1% of patients in the moxifloxacin group, compared with 4% of patients in the levofloxacin group. The differences were not statistically significant.
Dr. Niederman called the study unique “because it deals exclusively with older people with pneumonia, many of whom had heart disease and had very close cardiac monitoring to document the safety of these drugs.”
The study was sponsored by Bayer Pharmaceuticals Corp., which is the manufacturer of moxifloxacin.