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Survey: Physicians Prefer Daptomycin and Linezolid for MRSA Infections in Hospitals

Emerging therapies will need to demonstrate improvements over standard-of-care

Decision Resources Group, a health care research firm located in Burlington, Mass., finds that infectious disease (ID) specialists and non-ID physicians (critical care and internal medicine specialists) prefer the branded agents Cubicin (daptomycin, Cubist) and Zyvox (linezolid, Pfizer), respectively, when treating methicillin-resistant Staphylococcus aureus (MRSA) infections in the hospital.

Nearly half of surveyed ID specialists indicated that they preferred Cubicin for the treatment of bloodstream infections and/or endocarditis due to MRSA, whereas less than 20% of non-ID specialists indicated a preference for Cubicin in these indications. However, both physician groups preferred Zyvox for nosocomial pneumonia due to MRSA. This opinion was likely due to the results of post-marketing studies, which demonstrated the clinical superiority of linezolid over vancomycin.

Despite varying drug preferences between the two physician groups, vancomycin remains the most-prescribed antibiotic for MRSA infections by both ID specialists and non-ID physicians. The popularity of vancomycin may be attributed to physician familiarity, unrestricted formulary access, and the drug’s lower cost.

The survey also found that the MRSA market, particularly the complicated skin and skin-structure infection (cSSSI) segment, will become increasingly crowded, as three new antibiotics may launch in the U.S. in 2014. Cubist, Durata Therapeutics, and The Medicines Company have all filed new drug applications and marketing authorization applications for tedizolid, dalbavancin (Dalvance), and oritavancin, respectively.

“Dalbavancin and oritavancin have long systemic half-lives allowing for infrequent dosing,” said analyst Maria Ascano, PhD. “Therefore, the value proposition for these two agents will be their ability to reduce the health care cost by promoting early discharge and outpatient therapy. However, once-weekly or one-time dosing is a drastic departure from current standard-of-care, so physicians and pharmacy directors may be hesitant to widely prescribe these agents without further assessment of their efficacy and safety.”

Among hospital pharmacy directors who indicated that they would include tedizolid on formulary, only 15% said they would not include it if generic linezolid (priced at a 25% discount to branded Zyvox) were available, suggesting that pharmacy directors consider tedizolid sufficiently different from linezolid to merit the formulary inclusion of both agents.

According to surveyed physicians, one-half of hospital-treated patients with MRSA infection requiring further antibiotic therapy are discharged on oral agents — a practice that will favor therapies that are available in interchangeable intravenous (IV) and oral formulations. Such treatments promote IV–oral step-down and early hospital discharge. They can also reduce the length of hospital stays and lower the overall cost of care.

Source: Decision Resources; May 6, 2014.

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