LB-5. DAV132 Protects Intestinal Microbiota of Patients Treated with Quinolones, a European Phase II Randomized Controlled Trial (SHIELD)
Authors: Ducher Annie , Vehreschild Maria J G T , Vehreschild Maria J G T , Louie Thomas J , Cornely Oliver A , Féger Céline , Dane Aaron , Dane Aaron , Varastet Marina , de Gunzburg Jean , Andremont Antoine , Mentré France 
Published: January 2021

Abstract

Background
Antibiotics elicit intestinal dysbiosis with short and long-term deleterious effects. A colon-targeted adsorbent, DAV132, prevents dysbiosis in healthy humans and may protect antibiotic-treated patients.

Methods
Hospitalized patients receiving oral/iv fluoroquinolones (FQ) for the treatment of or prophylaxis of febrile neutropenia were randomized to receive DAV132 (7.5g tid orally), or not, during FQ receipt and followed up 51d. Plasma FQ levels were assessed at D4 (LC-MS/MS). Feces were collected during and up to 30d after FQ receipt for assessment of free fecal FQ levels (LC-MS/MS), gut microbiome α/β diversity (16S rRNA), resistance to colonization by C. difficile (Cd; ex-vivo proliferation). Relatedness of adverse events (AEs) to drugs was adjudicated by blinded independent experts.

Results
243 patients from 23 sites, median age 71y, ≥1 chronic comorbidity 95%, received levofloxacin (43%), ciprofloxacin (40%) or moxifloxacin (18%) for (79% iv). During receipt, fecal FQ levels were lowered by &gt;97% with DAV132 vs. No DAV132 (p&lt; 0.0001), whilst plasma levels did not change significantly. Microbiome diversity was significantly protected with DAV132 using all metrics, e.g. the change from D1 of Shannon index at End-of-FQ (difference of means at End-of-FQ 0.42, 95% CI: 0.085; 0.752). The proportions of patients with DAV132- and/or FQ-related AEs (primary endpoint) did not differ significantly (14.8 vs. 10.8%, difference of proportions: 3.9%; 95% CI: -4.7; 12.6). No Cd infection occurred. Resistance to colonization by Cd was reduced in stools of patients receiving FQ only, but was maintained in those of patients who also received DAV132 (p=0.035). The acquisition of fecal carriage of vancomycin-resistant enterococci (VRE) was reduced with DAV132 (p=0.019).
Figure 1: a. Free fluoroquinolones fecal concentration (mean ± SEM, µg/g) over time per FQ treatment group; b. Change of Shannon Index from baseline (mean ± SEM) over time

Conclusion
DAV132 was well tolerated in elderly hospitalized patients with comorbidities. It neither altered antibiotic plasma levels nor elicited changes in concomitant drugs regimens. Intestinal microbiota diversity was protected and resistance to colonization by Cd was preserved. DAV132 is a promising, novel product to prevent antibiotic-induced intestinal dysbiosis.

Disclosures
Annie Ducher, MD, Da Volterra (Employee, Shareholder) Maria J.G.T. Vehreschild, n/a, 3M (Grant/Research Support)Astellas Pharma (Grant/Research Support)Astellas Pharma (Consultant)Astellas Pharma (Speaker's Bureau)Basilea (Speaker's Bureau)Berlin Chemie (Consultant)Da Volterra (Grant/Research Support)Da Volterra (Grant/Research Support)Gilead (Grant/Research Support)Gilead (Speaker's Bureau)Merck/MSD (Speaker's Bureau)Merck/MSD (Grant/Research Support)MSD/Merck (Consultant)Organobalance (Grant/Research Support)Organobalance (Speaker's Bureau)Pfizer (Speaker's Bureau)Seres Therapeutics (Grant/Research Support) Thomas J. Louie, MD, Da Volterra (Consultant) Oliver A. Cornely, MD, Actelion (Consultant, Grant/Research Support, Speaker's Bureau)Al Jazeera Pharmaceuticals (Consultant)Allecra Therapeutics (Consultant, Grant/Research Support, Speaker's Bureau)Amplyx (Consultant, Grant/Research Support, Speaker's Bureau)Astellas (Consultant, Grant/Research Support, Speaker's Bureau)Basilea (Consultant, Grant/Research Support, Speaker's Bureau)Biosys UK Limited (Consultant, Grant/Research Support, Speaker's Bureau)Cidara (Consultant, Grant/Research Support, Speaker's Bureau)Da Volterra (Consultant, Grant/Research Support, Speaker's Bureau)Entasis (Consultant, Grant/Research Support, Speaker's Bureau)European Commission (Grant/Research Support)F2G (Consultant, Grant/Research Support, Speaker's Bureau)German Federal Ministry of Research andEducation (Grant/Research Support)Gilead (Consultant, Grant/Research Support, Speaker's Bureau)Grupo Biotoscana (Consultant, Grant/Research Support, Speaker's Bureau)Janssen Pharmaceuticals (Consultant, Grant/Research Support, Speaker's Bureau)Matinas (Consultant, Grant/Research Support, Speaker's Bureau)MedicinesCompany (Consultant, Grant/Research Support, Speaker's Bureau)MedPace (Consultant, Grant/Research Support, Speaker's Bureau)Melinta Therapeutics (Consultant, Grant/Research Support, Speaker's Bureau)Menarini Ricerche (Consultant, Grant/Research Support, Speaker's Bureau)Merck/MSD (Consultant, Grant/Research Support, Speaker's Bureau)Mylan Pharmaceuticals (Consultant)Nabriva (Consultant)Noxxon (Consultant)Octapharma (Consultant, Grant/Research Support, Speaker's Bureau)Paratek Pharmaceuticals (Consultant, Grant/Research Support, Speaker's Bureau)Pfizer (Consultant, Grant/Research Support, Speaker's Bureau)PSI (Consultant, Grant/Research Support, Speaker's Bureau)Roche Diagnostics (Consultant)Scynexis (Consultant, Grant/Research Support, Speaker's Bureau)Shionogi (Consultant) Céline Féger, PhD, Da Volterra (Consultant) Aaron Dane, MSc, Da Volterra (Consultant)Spero theraputics (Consultant) Aaron Dane, MSc, Spero theraputics (Consultant) Marina Varastet, PhD, Da Volterra (Employee) Jean de Gunzburg, PhD, Da Volterra (Board Member, Consultant, Shareholder) Antoine Andremont, PhD, Bioaster (Consultant)Da Volterra (Board Member, Consultant, Shareholder) France Mentré, MD, Da Volterra (Consultant)