Merck Announces Publication of Pivotal Data from Phase 3 Clinical Studies of ZERBAXA™ (Ceftolozane/Tazobactam) in The Lancet and Clinical Infectious Diseases
April 27, 2015 5:30 pm ET
Merck (NYSE:MRK), known as MSD outside the United States and Canada,
today announced that The Lancet and Clinical Infectious
Diseases have published online the results from the pivotal Phase 3
clinical studies of ZERBAXA™ (ceftolozane/tazobactam) for Injection (1
g/0.5 g) in complicated urinary tract infections (cUTI) and complicated
intra-abdominal infections (cIAI), respectively. The results will also
appear in forthcoming print issues of the journals. Merck acquired
ZERBAXA as a part of its purchase of Cubist Pharmaceuticals, Inc.
The publications report the results of two large, global, Phase 3
clinical studies of ZERBAXA – a study in patients with cUTI and a study
in patients with cIAI. Both studies met the pre-specified primary
endpoints, and results of the secondary analyses for the studies were
consistent with and supportive of the primary outcomes.
“Physicians are in need of new treatment options to address complicated
infections caused by serious Gram-negative bacteria. Publication of the
ZERBAXA Phase 3 clinical study results in The Lancet and Clinical
Infectious Diseases provides additional information to the
infectious disease community and continues to support ZERBAXA as a new
treatment for certain complicated urinary tract and complicated
intra-abdominal infections,” said René Russo, Pharm.D, BCPS, vice
president, global medical affairs, Cubist Pharmaceuticals.
Approved in the U.S., ZERBAXA is indicated for use in combination with
metronidazole in adult patients for the treatment of complicated
intra-abdominal infections caused by the following Gram-negative and
Gram-positive microorganisms: Enterobacter cloacae, Escherichia coli,
Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis,
Pseudomonas aeruginosa, Bacteroides fragilis, Streptococcus anginosus,
Streptococcus constellatus and Streptococcus salivarius.
ZERBAXA also is indicated in adult patients for the treatment of
complicated urinary tract infections, including pyelonephritis, caused
by the following Gram-negative microorganisms: Escherichia coli,
Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa.
To reduce the development of drug-resistant bacteria and maintain the
effectiveness of ZERBAXA and other antibacterial drugs, ZERBAXA should
be used only to treat infections that are proven or strongly suspected
to be caused by susceptible bacteria. When culture and susceptibility
information are available, they should be considered in selecting or
modifying antibacterial therapy. In the absence of such data, local
epidemiology and susceptibility patterns may contribute to the empiric
selection of therapy.
About the study of ZERBAXA in cUTI
As described in The Lancet, the cUTI study was a
multicenter, double-blind trial in which 1,083 hospitalized adult
patients with cUTI, including pyelonephritis, were randomized to receive
either intravenous (I.V.) ZERBAXA (1.5 g q8h) or high-dose I.V.
levofloxacin (750 mg qd) for seven days. In this study, treatment with
ZERBAXA was shown to be effective in patients with cUTI and
pyelonephritis, including a majority of infections caused by
levofloxacin-resistant pathogens. The comparator levofloxacin is a
common treatment option for cUTI and pyelonephritis, and is included in
international clinical practice guidelines for cUTI.
ZERBAXA met the study’s primary endpoint of statistical non-inferiority
compared to levofloxacin (10% non-inferiority margin). The primary
endpoint was a composite of microbiological eradication and clinical
cure rate (composite cure rate) at 5-9 days after the end of therapy
(the test of cure visit). The 95% confidence interval around the
treatment difference had lower and upper bounds of 2.3% and 14.6%,
“These clinical trial results are important because
ceftolozane/tazobactam is a new treatment option for patients facing
complicated urinary tract infections caused by certain susceptible
Gram-negative bacteria,” said The Lancet publication lead author
Florian M. Wagenlehner, M.D., Ph.D., Clinic for Urology, Pediatric
Urology and Andrology, Justus-Liebig University, and faculty member of
the German Center for Infection Research, Gießen-Marburg-Langen site.
“Gram-negative bacteria are prevalent globally and know no geographic
boundaries. With the increasing challenge of antibiotic resistance, the
treatment of complicated urinary tract infections has become more
difficult to manage, and new therapies are needed.”
About the study of ZERBAXA in cIAI
As described in Clinical Infectious Diseases, the cIAI study was
a multicenter, double-blind trial in which 993 hospitalized adult
patients with cIAI were randomized to receive either I.V. ZERBAXA (1.5 g
q8h) plus metronidazole (0.5 g q8h) or I.V. meropenem (1 g q8h) for four
to 10 days. Treatment could be continued for up to 14 days in patients
who had one of the following: multiple abscesses; non-appendix–related
diffuse peritonitis, failure of prior antimicrobial therapy, or
hospital-acquired infection. Treatment with ZERBAXA plus metronidazole
was shown to be effective in patients with cIAI, including those
infections caused by certain resistant pathogens, such as
extended-spectrum beta-lactamase (ESBL) producing Enterobacteriacae. The
comparator meropenem is a common treatment option for cIAI and is
included in international clinical practice guidelines for cIAI.
The primary endpoint of this study was the clinical cure rate 24-32 days
after the initiation of therapy (the test of cure visit). For the U.S.
Food and Drug Administration, the primary analysis was conducted in the
microbiological intent-to-treat population; the non-inferiority margin
was 10%; and the lower and upper bounds of the 95% confidence interval
were -8.9% and 0.5%, respectively. For the European Medicines Agency
(EMA), the primary analysis population was clinically evaluable
patients; the non-inferiority margin was 12.5%; and the lower and upper
bounds of the 99% confidence interval were -4.2% and 4.3%, respectively.
“Complicated intra-abdominal infections are tissue-invasive infections
that can lead to abscess formation or generalized peritonitis. Having
new antibiotics to address these types of serious infections,
particularly those caused by Gram-negative pathogens, has been a major
medical need,” said the Clinical Infectious Diseases publication
lead author Joseph Solomkin, M.D., professor of surgery emeritus,
Department of Surgery, University of Cincinnati College of Medicine.
“These clinical trial results reinforce that ZERBAXA is an effective new
treatment for adult patients with complicated intra-abdominal
About ZERBAXA (ceftolozane/tazobactam)
ZERBAXA, approved in the U.S., is an antibacterial combination product
consisting of the cephalosporin antibacterial drug ceftolozane sulfate
and the beta-lactamase inhibitor tazobactam sodium for intravenous
administration. The recommended dosage regimen of ZERBAXA is 1.5 g (1
g/0.5 g) administered every eight hours by intravenous infusion over one
hour in patients 18 years or older and with normal renal function or
mild renal impairment. Dosage adjustment is required for patients whose
creatinine clearance is 50 mL/min or less.
In the European Union, the EMA has accepted for review the Marketing
Authorization Application for ZERBAXA for the treatment of cUTI and
cIAI. A decision from the European Commission is expected during the
second half of 2015.
Important Safety Information about ZERBAXA
Patients with renal impairment: Decreased efficacy of ZERBAXA has
been observed in patients with baseline CrCl of 30 to <=50 mL/min. In a
clinical trial, patients with cIAIs with CrCl ≥50 mL/min had a clinical
cure rate of 85.2% when treated with ZERBAXA plus metronidazole vs 87.9%
when treated with meropenem. In the same trial, patients with CrCl 30 to
≤50 mL/min had a clinical cure rate of 47.8% when treated with ZERBAXA
plus metronidazole vs 69.2% when treated with meropenem. A similar trend
was also seen in the cUTI trial. Monitor CrCl at least daily in patients
with changing renal function and adjust the dose of ZERBAXA accordingly.
Hypersensitivity: ZERBAXA is contraindicated in patients with
known serious hypersensitivity to ceftolozane/tazobactam,
piperacillin/tazobactam, or other members of the beta-lactam class.
Serious and occasionally fatal hypersensitivity (anaphylactic) reactions
have been reported in patients receiving beta-lactam antibacterials.
Before initiating therapy with ZERBAXA, make careful inquiry about
previous hypersensitivity reactions to cephalosporins, penicillins, or
other beta-lactams. If an anaphylactic reaction to ZERBAXA occurs,
discontinue use and institute appropriate therapy.
Clostridium difficile–associated diarrhea (CDAD),
ranging from mild diarrhea to fatal colitis, has been reported with
nearly all systemic antibacterial agents, including ZERBAXA. Careful
medical history is necessary because CDAD has been reported to occur
more than two months after the administration of antibacterial agents.
If CDAD is confirmed, antibacterial use not directed against C.
difficile should be discontinued, if possible.
Development of drug-resistant bacteria: Prescribing ZERBAXA in
the absence of a proven or strongly suspected bacterial infection is
unlikely to provide benefit to the patient and increases the risk of the
development of drug resistant bacteria.
Adverse reactions: The most common adverse reactions occurring in
>= 5% of patients were headache (5.8%) in the cUTI trial, and nausea
(7.9%), diarrhea (6.2%) and pyrexia (5.6%) in the cIAI trial.
About Gram-negative bacteria and certain complicated infections
Gram-negative bacteria are a serious global public health concern. The
U.S. Centers for Disease Control and Prevention has categorized certain
Gram-negative bacteria among the most serious threats to public health.
Gram-negative bacteria are common causes of cIAI and cUTI. E. coli
is the most common cause of cUTIs, and cases of cUTI caused by Pseudomonas
aeruginosa are increasing. Additionally, Pseudomonas aeruginosa
is the second most common cause of catheter-associated UTIs. Major
pathogens in cUTIs are Enterobacteriaceae, including Escherichia coli
(E. coli) and Klebsiella pneumoniae.
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# # #
Please see Prescribing Information for ZERBAXA™
(ceftolozane/tazobactam) at http://zerbaxa.com/pdf/PrescribingInformation.pdf.
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