DOOR Analysis Shows Antibiotic Matches Standard Therapy in Effectiveness

The trial evaluating dalbavancin for Staphylococcus aureus bloodstream infections used Desirability of Outcome Ranking (DOOR) as its primary endpoint, offering a broader perspective than traditional single outcomes like mortality or recurrence. DOOR provides a patient-centered assessment by integrating both benefits and harms throughout treatment. Unlike conventional endpoints, which may define success simply as infection cure, DOOR accounts for complications along the way. For example, a patient who achieves cure but suffers a catheter-related infection and hospitalization during therapy is ranked lower than a patient who completes treatment without adverse events. DOOR then produces an interpretable probability: the likelihood that a patient on the experimental therapy experiences a more favorable overall outcome than one on standard treatment.

In this study, dalbavancin did not demonstrate superiority by DOOR but did achieve non-inferiority for efficacy, meaning it was as effective as standard therapy. Clinically, this positions dalbavancin as a viable alternative rather than a replacement. It does not outperform existing treatments but offers comparable effectiveness while potentially addressing patient-centered concerns such as treatment convenience, avoidance of prolonged IV access, and reduced hospital burden. For clinicians, the takeaway is that dalbavancin represents an additional therapeutic option, particularly valuable for patients who may benefit from its simplified regimen or who face risks associated with long-term intravenous therapy. Ultimately, DOOR helps frame this balance by showing not just whether treatment works, but how tolerable and safe the overall patient journey is.