title: Phase 2, Dose-Ranging Study of Relebactam with Imipenem-Cilastatin in Subjects with Complicated Intra-abdominal Infection.
abstract: Relebactam (REL [MK-7655]) is a novel class A/C β-lactamase inhibitor intended for use with imipenem for the treatment of Gram-negative bacterial infections. REL restores imipenem activity against some resistant strains of Klebsiella and Pseudomonas In this multicenter, double-blind, controlled trial (NCT01506271), subjects who were ≥18 years of age with complicated intra-abdominal infection were randomly assigned (1:1:1) to receive 250 mg REL, 125 mg REL, or placebo, each given intravenously (i.v.) with 500 mg imipenem-cilastatin (IMI) every 6 h (q6h) for 4 to 14 days. The primary efficacy endpoint was the proportion of microbiologically evaluable (ME) subjects with a favorable clinical response at discontinuation of i.v. therapy (DCIV). A total of 351 subjects were randomized, 347 (99%) were treated, and 255 (73%) were ME at DCIV (55% male; mean age, 49 years). The most common diagnoses were complicated appendicitis (53%) and complicated cholecystitis (17%). Thirty-six subjects (13%) had imipenem-resistant Gram-negative infections at baseline. Both REL doses plus IMI were generally well tolerated and demonstrated safety profiles similar to that of IMI alone. Clinical response rates at DCIV were similar in subjects who received 250 mg REL plus IMI (96.3%) or 125 mg REL plus IMI (98.8%), and both were noninferior to IMI alone (95.2%; one-sided P < 0.001). The treatment groups were also similar with respect to clinical response at early and late follow-up and microbiological response at all visits. Pharmacokinetic/pharmacodynamic simulations show that imipenem exposure at the proposed dose of 500 mg IMI with 250 mg REL q6h provides coverage of >90% of carbapenem-resistant bacterial strains.
authors: South Jersey Infectious Disease, Somers Point, New Jersey, USA.
authors: Christopher
authors: C
authors: Lucasti
authors: University of Medicine & Pharmacy, Craiova, Romania.
authors: Liviu
authors: L
authors: Vasile
authors: University of Medicine & Pharmacy, Timisoara, Romania.
authors: Dorel
authors: D
authors: Sandesc
authors: Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania.
authors: Donatas
authors: D
authors: Venskutonis
authors: Covance Inc., Princeton, New Jersey, USA.
authors: Patrick
authors: P
authors: McLeroth
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA.
authors: Mallika
authors: M
authors: Lala
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA.
authors: Matthew L
authors: ML
authors: Rizk
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA.
authors: Michelle L
authors: ML
authors: Brown
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA.
authors: Maria C
authors: MC
authors: Losada
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA.
authors: Alison
authors: A
authors: Pedley
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA.
authors: Nicholas A
authors: NA
authors: Kartsonis
authors: Merck & Co., Inc., Kenilworth, New Jersey, USA amanda.paschke@merck.com.
authors: Amanda
authors: A
authors: Paschke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D053961:Azabicyclo Compounds / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D015377:Cilastatin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077728:Cilastatin, Imipenem Drug Combination; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015378:Imipenem / Q000493:pharmacokinetics / Q000627:therapeutic use*; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D053961:Azabicyclo Compounds; D004338:Drug Combinations; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; C568736:relebactam