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Efficacy of Lefamulin for Community-Acquired Bacterial Pneumonia (CABP) Patients: Pooled Analysis of the Lefamulin Evaluation Against Pneumonia (LEAP) 1, LEAP 2 and LEAP China Trials

Shuo Liang, Yuhua Wen, Zhen-hua Zhang, Yi Shi, Jin-Fu Xu

Infection and Drug Resistance, 2025

728 participants · 3 citations

Abstract

Purpose Lefamulin represents a newly developed pleuromutilin antibiotic utilized for treating Community-Acquired Bacterial Pneumonia (CABP). Two pivotal Phase 3 studies, the Lefamulin Evaluation Against Pneumonia (LEAP) 1 and LEAP 2 trials, along with the bridging LEAP China trial, each confirmed that Lefamulin has proven efficacy and is non-inferior to active control treatments. This study conducted a post-hoc pooled analysis of these trials to assess Lefamulin’s overall efficacy and its effects on specific patient groups, particularly the elderly and those at high risk of drug resistance. Methods Trials compared lefamulin to moxifloxacin in adults with CABP. The primary outcome was early clinical response (ECR). Secondary outcomes included investigator assessment of clinical response (IACR), and these responses in subgroups, such as severe patients, elderly patients, and those with prior antibiotic treatment. The pooled analysis was conducted post hoc, using noninferiority margin of 10% and 95% confidence intervals. Results Lefamulin (n=728) can provide sustained high efficacy, which was noninferior to moxifloxacin (n=683). ECR and IACR success rates demonstrated similar elevation (≥ 84.0%). Comparable and elevated ECR and IACR rates across subgroup of PORT risk class III to V(84.1–88.6%) and subgroup of prior antibiotic treatment (81.8–85.6%) were observed. In the subgroup of age over 65 years old, higher ECR of lefamulin vs moxifloxacin in each ten years-stratification…

How strong is the evidence?

Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 728 participants or records.

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