5-year POET trial data continue to support oral antibiotics for left-sided endocarditis
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Five-year follow-up data from the POET trial continued to demonstrate the usefulness of oral antibiotics for left-sided endocarditis, with no indications of long-term treatment failure among participants, researchers reported.
The POET trial included 400 patients in stable condition with left-sided infective endocarditis who were randomly assigned to continue IV antibiotics or switch to step-down treatment with oral antibiotics after at least 10 days of initial IV treatment.
Researchers initially reported 6-month outcomes from the trial in August 2018, which showed that patients who switched to oral antibiotics had similar outcomes to those who remained on IV antibiotics. Three-year follow-up data reported in March 2019 demonstrated better rates of survival and other outcomes in the oral antibiotics arm of the trial.
In a post hoc analysis published in The New England Journal of Medicine, Henning Bundgaard, MD, DMSc, a professor of cardiology at Copenhagen University Hospital, and colleagues reported outcomes after a median follow-up of 5.4 years.
The primary outcome — a composite of death from any cause, unplanned cardiac surgery, embolic events and relapse of positive blood cultures after 6 months — occurred in 66 of 201 patients (32.8%) who received oral antibiotics and 90 of 199 (45.2%) who continued to receive IV antibiotics (HR = 0.65; 95% CI, 0.47-0.9), the researchers reported.
According to the authors, “The difference was driven mainly by a lower incidence of death from any cause in the group that had received step-down treatment ... than in the group that had received continued intravenous treatment.”
The authors noted there were no significant differences between the groups with regard to the additional three components of the primary outcome. The most frequent cause of death was cardiovascular, followed by infection and cancer.
“These reassuring findings further support current considerations of implementing step-down oral antibiotic therapy in selected patients with endocarditis on the left side of the heart,” the authors wrote.
Perspective
Back to TopKelly M. Percival, PharmD, BCPS, BCIDP
I think it is a good follow-up to solidify that those who received oral treatment did continue to do well and there were no major negative outcomes after the initial study period. Also, any adverse events that did occur did not seem to affect life expectancy.
I do not make too much out of the fact that in the data, the IV treatment group actually seemed to do worse in the long term. I think that may be driven to some degree by chance because the average age of the participants at the time of the study was 67 years old. Also, in the initial 6 months it was similar, which would be when I would most expect to see complications from a long-term hospitalization (risk for acquiring another infection, etc.). The fact that the gap widened with time wouldn't be explained by that in my opinion. Maybe there is something driving it beyond chance, but nothing obvious sticks out to me.
I still struggle with some of the general limitations of the initial study and how that would translate to clinical practice vs. clinical trial because they had frequent follow-up visits, which probably helped adherence to the oral regimens that contain a fairly high pill burden.
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