Merck announced results from RESTORE-IMI 2, a randomized, controlled, double-blind Phase 3 clinical trial evaluating RECARBRIO™ (imipenem, cilastatin, and relebactam) for the treatment of adults with hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP). The results demonstrated noninferiority of RECARBRIO compared to piperacillin and tazobactam (PIP/TAZ), the active comparator, in the primary and key secondary endpoints of the study, 28-day all-cause mortality and clinical response, respectively. In February 2020, the U.S. Food and Drug Administration (FDA) accepted for review a supplemental New Drug Application (sNDA) for use of RECARBRIO in this patient population. The FDA Prescription Drug User Fee Act (PDUFA) goal date is June 4, 2020. Phase 3 trial data are now available in a compendium of presentations posted by Merck, coinciding with publication of study abstracts by the 30th European Congress of Clinical Microbiology & Infectious Diseases (ECCMID).
“We are pleased to post results from the RESTORE-IMI 2 clinical trial, which further demonstrate the potential of RECARBRIO to treat HABP/VABP due to certain susceptible Gram-negative pathogens,” said Dr. Joan Butterton, associate vice president, infectious disease clinical research, Merck Research Laboratories. “These data underscore Merck’s commitment to pursuing innovative options for those in need of novel antibiotic treatments.”
RESTORE-IMI 2 Design
RESTORE-IMI 2 was a Phase 3 multinational, randomized, double-blind, non-inferiority trial evaluating the efficacy and safety of RECARBRIO versus PIP/TAZ in adult patients with HABP/VABP. In the study, 537 patients at 113 clinical trial sites were randomized 1:1 to receive a dose of RECARBRIO (imipenem 500 mg/cilastatin 500 mg/relebactam 250 mg) or PIP/TAZ (piperacillin 4000 mg/tazobactam 500 mg), each given intravenously every six hours for seven to 14 days. Patients in both treatment groups also received open label empiric linezolid (600 mg) until baseline cultures confirmed absence of methicillin-resistant Staphylococcus aureus (MRSA). The primary endpoint was Day 28 all-cause mortality and the key secondary endpoint was clinical response at early follow-up (seven to 14 days after completing therapy).
RESTORE-IMI 2 Results
RECARBRIO met its primary and key secondary endpoints, demonstrating non-inferiority compared to PIP/TAZ. For patients treated with RECARBRIO, Day 28 all-cause mortality (primary endpoint) was 15.9% (42/264) compared with 21.3% (57/267) in those treated with PIP/TAZ (adjusted treatment difference: 5.3%, 95% confidence interval [CI]: -11.9, 1.2). For patients treated with RECARBRIO, a favorable clinical response at early follow-up (key secondary endpoint) was observed in 60.9% (161/264) compared with 55.8% (149/267) in the PIP/TAZ group (adjusted treatment difference: 5%, 95% CI: -3.2, 13.2).
Rates of overall adverse events (AEs) were similar between treatment groups, with 84.9% (226/266) in the RECARBRIO arm vs. 86.6% (233/269) in the PIP/TAZ arm, reporting at least one AE. AEs classified as drug-related by the investigator were 12% (31/266) in the RECARBRIO arm vs. 10% (26/269) in the PIP/TAZ arm. Additionally, therapy discontinuations due to any AE were similar in both groups, with 6% (15/266) in the RECARBRIO arm vs. 8% (22/269) in the PIP/TAZ arm. Therapy discontinuations due to drug-related AEs were also similar: 2.3% (6/266) in the RECARBRIO arm vs. 1.5% (4/269) in the PIP/TAZ arm. The most frequently reported (>5 patients) drug-related AEs in the RECARBRIO arm were diarrhea and elevated levels of the liver function biomarkers alanine aminotransferase and aspartate aminotransferase (2% each [6/266]).
About RECARBRIO™ (imipenem 500 mg, cilastatin 500 mg, and relebactam 250 mg)
RECARBRIO was initially approved by the FDA in July 2019 for the treatment of complicated urinary tract infections (cUTI), including pyelonephritis, and complicated intra-abdominal infections (cIAI), caused by susceptible Gram-negative bacteria, in adults who have limited or no alternative treatment options.
RECARBRIO is indicated in patients 18 years of age and older who have limited or no alternative treatment options, for the treatment of complicated urinary tract infections (cUTI), including pyelonephritis, caused by the following susceptible Gram-negative microorganisms: Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, Klebsiella pneumoniae, and Pseudomonas aeruginosa.
RECARBRIO is also indicated in patients 18 years of age or older who have limited or no alternative treatment options, for the treatment of complicated intra-abdominal infections (cIAI) caused by the following susceptible Gram-negative microorganisms: Bacteroides caccae, Bacteroides fragilis, Bacteroides ovatus, Bacteroides stercoris, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Fusobacterium nucleatum, Klebsiella aerogenes, Klebsiella oxytoca, Klebsiella pneumoniae, Parabacteroides distasonis and Pseudomonas aeruginosa.
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