The SNAP Trial with Professors Tong and Davis

In this episode of "In the Interim…", Dr. Scott Berry interviews Professors Steven Tong and Josh Davis about the SNAP platform trial for Staphylococcus aureus bacteremia. The discussion covers SNAP’s rationale, large-scale adaptive design, methodology, and operational execution at approximately 150 hospitals in 13 countries. Key statistical questions, domain results, pediatric-adult analysis, and global implementation strategy are explored in depth. Listeners will find clear examples of how adaptive platform trials can efficiently address clinically relevant questions in infectious disease, while highlighting the nuances of trial design, statistical thresholds, and network collaboration.

Key Highlights

• High and unchanging mortality for Staphylococcus aureus bacteremia—over one million deaths annually.
• SNAP leverages silo-based structure (MSSA, MRSA, PSSA) and factorial domains for simultaneous, efficient investigation of treatments.
• Cefazolin shown non-inferior to flucloxacillin for MSSA with lower related acute kidney injury.
• In PSSA, penicillin demonstrated significantly less toxicity and favorable mortality signal over flucloxacillin; mortality difference did not meet the statistical superiority threshold.
• Futility reached in the adjunctive clindamycin domain for effect on 90-day mortality.
• Both adults and children enrolled, with pediatric results using statistical borrowing from adults in line with FDA Bayesian guidance.
• Ongoing platform expansion includes bacteriophage therapy, antiplatelet domains, and evaluation of diagnostic strategies.
• Statistical leadership: Dr. Anna McGlothlin (Berry Consultants), Dr. Julie Marsh (statistics lead).

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