3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

RESTORE-IMI 1: A Multicenter, Randomized, Double-blind Trial Comparing Efficacy and Safety of Imipenem/Relebactam vs Colistin Plus Imipenem in Patients With Imipenem-nonsusceptible Bacterial Infections

f:id:akinohanayuki:20190814061421j:plain

 

CIDから報告された、P3であるRESTORE-IMI 1。

 

Patients With Imipenem-nonsusceptible Bacterial Infections

Imipenem/Relebactam vs Colistin Plus Imipenem

 

academic.oup.com

感想・まとめ

 

差がなさそう。腎障害嫌だなオプションが増えてよかったです。

日常的に使わないことを祈ってますが。

 

Primary endpoint

Favorable overall response was observed in 71% imipenem/relebactam and 70% colistin+imipenem patients (90% CI for difference, –27.5, 21.4)

 

Secondary endpoints

day 28 favorable clinical response in 71% and 40% (90% CI, 1.3, 51.5)

28-day mortality in 10% and 30% (90% CI, –46.4, 6.7)

 

Serious adverse events (AEs)

10% of imipenem/relebactam and 31% of colistin+imipenem patients,

drug-related AEs in 16% and 31% (no drug-related deaths)

treatment-emergent nephrotoxicity in 10% and 56% (P = .002),

 

Abstract


Background

The β-lactamase inhibitor relebactam can restore imipenem activity against imipenem-nonsusceptible gram-negative pathogens. We evaluated imipenem/relebactam for treating imipenem-nonsusceptible infections.

Methods

Randomized, controlled, double-blind, phase 3 trial. Hospitalized patients with hospital-acquired/ventilator-associated pneumonia, complicated intraabdominal infection, or complicated urinary tract infection caused by imipenem-nonsusceptible (but colistin- and imipenem/relebactam-susceptible) pathogens were randomized 2:1 to 5–21 days imipenem/relebactam or colistin+imipenem. Primary endpoint: favorable overall response (defined by relevant endpoints for each infection type) in the modified microbiologic intent-to-treat (mMITT) population (qualifying baseline pathogen and ≥1 dose study treatment). Secondary endpoints: clinical response, all-cause mortality, and treatment-emergent nephrotoxicity. Safety analyses included patients with ≥1 dose study treatment.

Results

Thirty-one patients received imipenem/relebactam and 16 colistin+imipenem. Among mITT patients (n = 21 imipenem/relebactam, n = 10 colistin+imipenem), 29% had Acute Physiology and Chronic Health Evaluation II scores >15, 23% had creatinine clearance <60 mL/min, and 35% were aged ≥65 years. Qualifying baseline pathogens: Pseudomonas aeruginosa (77%), Klebsiella spp. (16%), other Enterobacteriaceae (6%). Favorable overall response was observed in 71% imipenem/relebactam and 70% colistin+imipenem patients (90% confidence interval [CI] for difference, –27.5, 21.4), day 28 favorable clinical response in 71% and 40% (90% CI, 1.3, 51.5), and 28-day mortality in 10% and 30% (90% CI, –46.4, 6.7), respectively. Serious adverse events (AEs) occurred in 10% of imipenem/relebactam and 31% of colistin+imipenem patients, drug-related AEs in 16% and 31% (no drug-related deaths), and treatment-emergent nephrotoxicity in 10% and 56% (P = .002), respectively.

Conclusions

Imipenem/relebactam is an efficacious and well-tolerated treatment option for carbapenem-nonsusceptible infections.

Clinical Trials Registration

NCT02452047.

 

f:id:akinohanayuki:20190814061228j:plain