Abstract
BACKGROUND: Few studies have compared the efficacy and safety of omadacycline with other treatments for acute bacterial skin and skin structure infections (ABSSSI). Therefore, updated meta-analyses on this topic is necessary. METHODS: We conducted a network meta-analysis (NMA) of randomized controlled trials (RCTs) to compare omadacycline with other anti-MRSA antibiotics. A systematic search of seven databases was undertaken to identify eligible RCTs enrolling adults with ABSSSI. Two reviewers independently assessed the quality of the included studies and three reviewers independently extracted data from all manuscripts. All meta-analyses were performed using R software. RESULTS: Our NMA included 39 RCTs with a total of 20,862 patients with ABSSSI. Eighteen anti-MRSA antibiotics were analyzed in the NMA. In terms of early clinical response, omadacycline was comparable to oxazolidinones like linezolid, tedizolid, and contezolid. Across various populations, including the intention-to-treat (ITT), modified ITT, and clinically evaluable populations, omadacycline showed higher or comparable clinical success rates, although these results were of borderline statistical significance. The results showed that omadacycline ranked first in efficacy among 18 antibiotics, based on surface under the cumulative ranking curve values. Additionally, omadacycline had significantly fewer serious adverse events than telavancin and demonstrated a safety profile comparable to other antibiotics. CONCLUSIONS: Our findings indicate that omadacycline is a promising treatment option for ABSSSI, demonstrating efficacy that is comparable to or potentially superior to many other anti-MRSA agents, along with a favorable safety profile. However, these results should be interpreted with caution due to the study's inherent limitations.