Greatest International ANtiinfective Trial (GIANT) with moxifloxacin in the treatment of acute exacerbation of  chronic bronchitis: subanalysis of Chinese data of a global, multicenter, noninterventional study

Yulin Feng¹, Faguang Jin², Shuang Mu³, Hong Shen⁴, Xiaohong Yang⁵, Yuling Wang⁶, Zhenshan Wang⁷, Yingjun Kong⁸, Zuke Xiao⁹, Qiming Feng¹⁰

¹Respiratory Department, West China Hospital, Sichuan University, China; ²Respiratory Department, Tang Du Hospital, China; ³Respiratory Department, Peking University People’s Hospital, China; ⁴Emergency Department, The General Hospital of the People’s Liberation Army, China; ⁵Respiratory Department, Xinjiang People’s Hospital, China; ⁶Respiratory Department, Shi Jiazhuang First Hospital, China; ⁷Respiratory Department, The Second Affiliated Hospital of Dalian Medical University, China; ⁸Respiratory Department, The First Clinical College of Harbin Medical University, China; ⁹Respiratory Department, The Jiangxi Provincial People’s Hospital, China; ¹⁰Emergency Department, Shanghai Sixth People’s Hospital, China

Background and objective: A single infective acute exacerbation of chronic bronchitis (AECB) has a sustained effect on health status. Although a number of clinical investigations have demonstrated the efficacy of antibiotics in AECB, increased bacterial resistance has caused concern about the efficacy of currently available antibiotic therapies. This subanalysis of a global noninterventional study aimed to evaluate the impact of AECB on the patient and the community and the effectiveness and safety of a treatment with moxifloxacin (MXF) tablets in daily life clinical practice in China.

Methods: This prospective, noninterventional, noncontrolled, multicenter observational study, which started in China in April 2004 and ended in February 2007, was part of the global GIANT study. Patients with a diagnosis of mild to severe AECB were treated with MXF tablets 400 mg for a period at the physician’s discretion. The observation period for each patient covered a complete treatment period with MXF. For each patient, the physician documented data at an initial visit (baseline) and at least one follow-up visit. Data were collected on demography, diagnosis of infection, pretreatment, concomitant diseases and medications, MXF therapy, course of symptoms during investigations, and final assessment of therapy with respect to MXF.

Results: In the Chinese subset of the GIANT study, a total of 11,377 patients were included in the intention-to-treat/safety population. At the end of the initial treatment period, improvement and recovery from infection was observed for 98.6% (n = 11,217/11,377) and 92.6% (n = 10,540/11,377) of all patients. After 1 week of treatment, 76.3% (n = 8681/11,377) of patients had recovered. Median time until improvement and recovery was 3.0 and 6.0 days, respectively. Correspondingly, in 95.8% (n = 10,903/11,377) of all patients, overall effectiveness during the initial treatment period with MXF was assessed as “very good” or “good”. Compared with the last AECB, the number of days with impact on daily-life activities and the number of nights with sleep disturbances decreased from 3.0 to 2.0 (median) and from 2.0 to 1.0 (median), respectively. In general, MXF treatment was very well tolerated, with physician’s overall assessment of tolerability as “good” or “very good” in 95.2% (n = 10,834/11,377) of patients. The incidence rate of adverse events and adverse drug reactions was 0.82% (n = 93) and 0.67% (n = 76), respectively. The most frequent adverse events were gastrointestinal disorders such as nausea (0.31%, n = 35) and vomiting (0.19%, n = 22), which were mostly drug-related. One individual serious adverse event (dyspnea) occurred during the observation period, which was assessed as drug-related.

Conclusion: MXF was effective and well tolerated in patients suffering from AECB. The fast speed of the drug’s onset of action was associated with rapid improvement of clinical parameters.

Keywords: China, moxifloxacin, chronic bronchitis, acute exacerbation, GIANT