• Antoni Torres, Lynne Garrity-Ryan, Courtney Kirsch, Judith N Steenbergen, Paul B Eckburg, Anita F Das, Marla Curran, Amy Manley, Evan Tzanis, and Paul C McGovern.
• Servei de Pneumologia, Hospital Clinic, Barcelona, Universitat de Barcelona, Spain. Electronic address: atorres@clinic.cat.
• Int. J. Infect. Dis. 2021 Mar 1; 104: 501-509.

ObjectiveCommunity-acquired bacterial pneumonia (CABP) is a major clinical burden worldwide. In the phase III OPTIC study (NCT02531438) in CABP, omadacycline was found to be non-inferior to moxifloxacin for investigator-assessed clinical response (IACR) at post-treatment evaluation (PTE, 5-10 days after last dose). This article reports the efficacy findings, as specified in the European Medicines Agency (EMA) guidance.MethodsPatients were randomized 1:1 to omadacycline 100 mg intravenously (every 12 h for two doses, then every 24 h) with optional transition to 300 mg orally after 3 days, or moxifloxacin 400 mg intravenously (every 24 h) with optional transition to 400 mg orally after 3 days. The total treatment duration was 7-14 days. The primary endpoint for EMA efficacy analysis was IACR at PTE in patients with Pneumonia Patient Outcomes Research Team (PORT) risk class III and IV.ResultsIn total, 660 patients were randomized as PORT risk class III and IV. Omadacycline was non-inferior to moxifloxacin at PTE. The clinical success rates were 88.4% and 85.2%, respectively [intent-to-treat population; difference 3.3; 97.5% confidence interval (CI) -2.7 to 9.3], and 92.5% and 90.5%, respectively (clinically evaluable population; difference 2.0; 97.5% CI 3.2-7.4). Clinical success rates with omadacycline and moxifloxacin were similar against identified pathogens and across key subgroups.ConclusionsOmadacycline was non-inferior to moxifloxacin for IACR at PTE, with high clinical success across pathogen types and patient subgroups.Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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