The FDA approval of VABOMERE was supported by TANGO-1, a Phase III, multi-center, randomized, double-blind, double-dummy study to evaluate the efficacy, safety and tolerability of VABOMERE compared to piperacillin-tazobactam in the treatment of cUTI, including acute pyelonephritis, in adults. The trial enrolled 550 adult patients who were randomized 1:1 to receive VABOMERE (meropenem 2g - vaborbactam 2g) as a three-hour IV infusion every eight hours, or piperacillin 4g - tazobactam 500mg as a 30-minute IV infusion every eight hours, each for up to 10 days.The primary assessment was performed in the microbiologic modified intent-to-treat (mMITT) patient population, and was defined as overall success of clinical outcome (cure or improvement) and microbiologic outcome of eradication (baseline bacterial pathogen reduced to < 10 4 CFU/ml). Overall success was observed in 183/186 patients (98.4%) in the meropenem-vaborbactam group and in 165/175 patients (94.3%) in the piperacillin-tazobactam group - a difference of 4.1% (95% CI: 0.3% to 8.8%). The most common adverse events for VABOMERE included headache, infusion site reactions and diarrhea. Michael Dudley, PharmD, FIDSA, Senior Vice President, Head of R&D and Co-Leader for The Medicines Company's Infectious Disease Business, noted, "We are grateful for the support of patients, families, and investigators that contributed to the rapid development of VABOMERE as it progressed from discovery in our laboratories to availability for patients in under eight years. This unprecedented speed has, in no small way, been due to our outstanding collaboration with, and support received from, the Biomedical Advanced Research and Development Authority (BARDA)." Data from the TANGO clinical program, including data from TANGO-2, a multi-center, randomized, open-label clinical trial of VABOMERE versus "best available therapy" in subjects with known or suspected carbapenem-resistant Enterobacteriaceae (CRE), will be presented at IDWeek 2017, to be held October 4-8, 2017 in San Diego. Last month, the Company announced cessation of enrollment in TANGO-2 following a recommendation by the independent Data and Safety Monitoring Board, which concluded that a risk-benefit analysis of available data no longer supported randomization of additional patients to the "best available therapy" comparator arm.
We expect that VABOMERE will be available in the fourth quarter of 2017. The FDA approval of VABOMERE triggered a $40 million milestone payment obligation to the former securityholders of Rempex Pharmaceuticals, Inc., which we acquired in December 2013.About VABOMERE™ (meropenem and vaborbactam) for Injection VABOMERE™ (meropenem and vaborbactam) is indicated for the treatment of patients 18 years of age and older with complicated urinary tract infections (cUTI) including pyelonephritis caused by the following susceptible microorganisms: Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae species complex. To reduce the development of drug-resistant bacteria and maintain the effectiveness of VABOMERE and other antibacterial drugs, VABOMERE should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. Highlights of Prescribing Information Dosage and Administration Recommended Dosage The recommended dosage of VABOMERE is 4 grams (meropenem 2 grams and vaborbactam 2 grams) administered every 8 hours by intravenous (IV) infusion over 3 hours in patients 18 years of age and older with an estimated glomerular filtration rate (eGFR) greater than or equal to 50 mL/min/1.73m2. The duration of treatment is for up to 14 days. Dosage Adjustments in Patients with Renal Impairment Dosage adjustment is recommended in patients with renal impairment who have an eGFR less than 50 mL/min/1.73m2. The recommended dosage of VABOMERE in patients with varying degrees of renal function is presented in Table 1 (below). For patients with changing renal function, monitor serum creatinine concentrations and eGFR at least daily and adjust the dosage of VABOMERE accordingly. Meropenem and vaborbactam are removed by hemodialysis. For patients maintained on hemodialysis, administer VABOMERE after a hemodialysis session. Table 1: Dosage of VABOMERE in Patients with Renal Impairment
|eGFRa (mL/min/1.73m2)||Recommended Dosage Regimen for VABOMERE (meropenem and vaborbactam)b, c, d||Dosing Interval|
|30 to 49||VABOMERE 2 grams (meropenem 1 gram andvaborbactam 1 gram)||Every 8 hours|
|15 to 29||VABOMERE 2 grams (meropenem 1 gram andvaborbactam 1 gram)||Every 12 hours|
|Less than 15||VABOMERE 1 gram (meropenem 0.5 gramsand vaborbactam 0.5 grams)||Every 12 hours|
|a.||As calculated using the Modification of Diet in Renal Disease (MDRD) formula as follows: eGFR (mL/min/1.73m2) = 175 x (serum creatinine)-1.154 x (age)-0.203x (0.742 if female) x (1.212 if African American).|
|b.||All doses of VABOMERE are administered intravenously over 3 hours.|
|c.||Doses adjusted for renal impairment should be administered after a hemodialysis session.|
|d.||The total duration of treatment is for up to 14 days.|
The vaborbactam component of VABOMERE is a non-suicidal beta-lactamase inhibitor that protects meropenem from degradation by certain serine beta-lactamases such as Klebsiella pneumoniae carbapenemase (KPC). Vaborbactam does not have any antibacterial activity. Vaborbactam does not decrease the activity of meropenem against meropenem-susceptible organisms.Resistance Mechanisms of beta-lactam resistance may include the production of beta-lactamases, modification of PBPs by gene acquisition or target alteration, up-regulation of efflux pumps, and loss of outer membrane porin. VABOMERE may not have activity against gram-negative bacteria that have porin mutations combined with overexpression of efflux pumps. Clinical isolates may produce multiple beta-lactamases, express varying levels of betalactamases, or have amino acid sequence variations, and other resistance mechanisms that have not been identified. Culture and susceptibility information and local epidemiology should be considered in selecting or modifying antibacterial therapy. VABOMERE demonstrated in vitro activity against Enterobacteriaceae in the presence of some beta-lactamases and extended-spectrum beta-lactamases (ESBLs) of the following groups: KPC, SME, TEM, SHV, CTX-M, CMY, and ACT. VABOMERE is not active against bacteria that produce metallo-beta lactamases or oxacillinases with carbapenemase activity. In the Phase 3 cUTI trial with VABOMERE, some isolates of E. coli, K. pneumoniae, E. cloacae, C. freundii, P. mirabilis, P. stuartii that produced beta-lactamases, were susceptible to VABOMERE (minimum inhibitory concentration =4 mcg /mL). These isolates produced one or more beta-lactamases of the following enzyme groups: OXA (non-carbapenemases), KPC, CTX-M, TEM, SHV, CMY, and ACT. Some beta-lactamases were also produced by an isolate of K. pneumoniae that was not susceptible to VABOMERE (minimum inhibitory concentration =32 mcg/mL). This isolate produced beta-lactamases of the following enzyme groups: CTX-M, TEM, SHV, and OXA. No cross-resistance with other classes of antimicrobials has been identified. Some isolates resistant to carbapenems (including meropenem) and to cephalosporins may be susceptible to VABOMERE.
Interaction with Other AntimicrobialsIn vitro synergy studies have not demonstrated antagonism between VABOMERE and levofloxacin, tigecycline, polymyxin, amikacin, vancomycin, azithromycin, daptomycin, or linezolid. Activity against Meropenem Non-susceptible Bacteria in Animal Infection Models Vaborbactam restored activity of meropenem in animal models of infection (e.g., mouse thigh infection, urinary tract infection and pulmonary infection) caused by some meropenem non-susceptible KPC-producing Enterobacteriaceae. Antimicrobial Activity VABOMERE has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections. Gram-negative bacteria:
- Enterobacter cloacae species complex
- Escherichia coli
- Klebsiella pneumoniae
- Citrobacter freundii
- Citrobacter koseri
- Enterobacter aerogenes
- Klebsiella oxytoca
- Morganella morganii
- Proteus mirabilis
- Providencia spp.
- Pseudomonas aeruginosa
- Serratia marcescens
Dilution TechniquesQuantitative methods are used to determine antimicrobial MICs. These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized test method (broth and/or agar). The MIC values should be determined using serial dilutions of meropenem combined with a fixed concentration of 8 mcg/mL of vaborbactam. The MIC values should be interpreted according to the criteria in Table 6 (below). Diffusion Techniques Quantitative methods that require measurement of zone diameters can also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. The zone size should be determined using a standardized method. This procedure uses paper disks impregnated with 20 mcg of meropenem and 10 mcg vaborbactam to test the susceptibility of bacteria to meropenem and vaborbactam. The disk breakpoints are provided in Table 6 (below). Table 6: Susceptibility Interpretive Criteria for Meropenem/Vaborbactam
|Pathogen||Minimum Inhibitory Concentrations (mcg/mL)||Disk Diffusion(zone diameters in mm)|
A report of Susceptible (S) indicates that the antimicrobial drug is likely to inhibit growth of the pathogen if the antimicrobial drug reaches the concentration usually achievable at the site of infection. A report of Intermediate (I) indicates that the result should be considered equivocal, and, if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where a high dosage of the drug can be used. This category also provides a buffer zone that prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of Resistant (R) indicates that the antimicrobial drug is not likely to inhibit growth of the pathogen if the antimicrobial drug reaches the concentrations usually achievable at the infection site; other therapy should be selected.Quality Control Standardized susceptibility test procedures require the use of laboratory controls to monitor and ensure the accuracy of supplies and reagents used in the assay, and the techniques of the individuals performing the test. Standard meropenem and vaborbactam powder should provide the following range of MIC values noted in Table 7 (below). For the diffusion technique using the 20 mcg meropenem/10 mcg vaborbactam disk, the criteria in Table 6 (above) should be achieved. Table 7: Acceptable Quality Control Ranges for Meropenem/Vaborbactam
|Quality Control Strain||Minimum Inhibitory Concentration (mcg/mL)||Disk Diffusion (zone diameter in mm)|
|Klebsiella pneumoniae ATCC BAA-1705*||0.015/8-0.06/8||21-27|
|Klebsiella pneumoniae ATCC BAA-2814*||-||16-20|
|Pseudomonas aeruginosa ATCC 27853||0.12/8-1/8||29-35|
|Escherichia coli ATCC 25922||0.008/8-0.06/8||31-37|
|Escherichia coli ATCC 35218||0.008/8-0.06/8||-|
|Klebsiella pneumoniae ATCC 700603||0.015/8-0.06/8||29-35|
|Staphylococcus aureus ATCC 25923||-||32-38|
|Staphylococcus aureus ATCC 29213||0.03/8-0.12/8||-|
|ATCC = American Type Culture Collection|
|*KPC-producing K. pneumoniae included for the QC of vaborbactam activity|
Warnings and Precautions
- Hypersensitivity reactions were reported in patients treated with VABOMERE in the clinical trials. Serious and occasionally fatal hypersensitivity (anaphylactic) reactions and serious skin reactions have been reported in patients receiving therapy with beta-lactam antibacterial drugs. There have been reports of individuals with a history of penicillin hypersensitivity who have experienced severe hypersensitivity reactions when treated with another beta-lactam antibacterial drug. If an allergic reaction to VABOMERE occurs, discontinue the drug immediately.
- Seizures and other adverse Central Nervous System (CNS) experiences have been reported during treatment with meropenem, which is a component of VABOMERE. Close adherence to the recommended dosage regimens is urged, especially in patients with known factors that predispose to convulsive activity.
- Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including VABOMERE, and may range in severity from mild diarrhea to fatal colitis. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may ne45ed to be discontinued.
- The concomitant use of VABOMERE and valproic acid or divalproex sodium is generally not recommended. Case reports in the literature have shown that co-administration of carbapenems, including meropenem, to patients receiving valproic acid or divalproex sodium results in a reduction in valproic acid concentrations. The valproic acid concentrations may drop below the therapeutic range as a result of this interaction, therefore increasing the risk of breakthrough seizures. If administration of VABOMERE is necessary, consider supplemental anticonvulsant therapy.
- In patients with renal impairment, thrombocytopenia has been observed in patients treated with meropenem, but no clinical bleeding has been reported.
- Alert patients receiving VABOMERE on an outpatient basis regarding adverse reactions such as seizures, delirium, headaches and/or paresthesias that could interfere with mental alertness and/or cause motor impairment.
- Prescribing VABOMERE in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of drug-resistant bacteria.
- As with other antibacterial drugs, prolonged use of VABOMERE may result in overgrowth of nonsusceptible organisms.
Please see www.vabomere.com for the full prescribing information.About The Infectious Disease Business The Medicines Company Infectious Disease Business (MDCO IDC) is committed to bringing life-saving antimicrobial products to patients with the most serious drug-resistant infections - infections caused by "super bugs" which are no longer treatable with available antibiotics. MDCO IDC encompasses basic research and drug discovery focused on bacterial mechanisms of drug resistance; drug development focused on the most threatening bacterial diseases; and a distribution and commercial infrastructure that serves the leading hospitals and healthcare facilities in the United States. MDCO IDC also has a leading pipeline of novel agents directed towards existing and emerging multidrug-resistant bacteria. In addition to the development and approval of VABOMERE, MDCO IDC has, since 2014, successfully developed and launched two antibiotics against serious infections: ORBACTIV ® (oritavancin) for the treatment of acute bacterial skin and skin-structure infections in adults, caused by designated pathogens, including methicillin-resistant Staphylococcus aureus, and a new formulation of MINOCIN ® (minocycline) for Injection, which is among the few FDA-approved agents for the treatment of infections due to Acinetobacter spp., a pathogen classified by the CDC to be a serious antimicrobial resistance threat. For more information on these products, including their respective important safety information and package inserts, please see www.orbactiv.com and www.minociniv.com. About BARDA In February 2014, The Medicines Company Infectious Disease Business was awarded a cost-sharing contract by the Biomedical Advanced Research and Development Authority (BARDA), a division of the Office of the Assistant Secretary for Preparedness and Response within the U.S. Department of Health and Human Services (HHS), of which $55.8 million in federal funds have been obligated to date to support the development of VABOMERE. In September 2016, The Medicines Company entered into a new strategic partnership with BARDA that will provide the Company with the potential for up to $132 million to support the development of new antibiotics to fight drug-resistant, gram-negative infections (HHSO100201600026C). The partnership was established under HHS's Other Transactional Authority (OTA), and is a distinctive, flexible, portfolio-based approach to funding drug development. The Medicines Company was awarded $32 million in initial funding, and up to an additional $100 million (pending the availability of funding) over approximately five years, if all options to extend the partnership are exercised by BARDA and The Medicines Company. The initial $32 million award supports further development of VABOMERE as well as advancement of the Company's early stage pipeline. Funding provided under any subsequent options exercised by BARDA and The Medicines Company, will also support the advancement of antibiotics in MDCO IDC's portfolio of new antibiotic drug candidates targeting drug resistant bacteria.
About The Medicines CompanyThe Medicines Company is a biopharmaceutical company driven by an overriding purpose - to save lives, alleviate suffering and contribute to the economics of healthcare. The Company's mission is to create transformational solutions to address the most pressing healthcare needs facing patients, physicians and providers in serious infectious disease care and cardiovascular care. The Company is headquartered in Parsippany, New Jersey, with global innovation centers in California and Switzerland. Forward-Looking Statements Statements contained in this press release that are not purely historical may be deemed to be forward-looking statements for purposes of the safe harbor provisions under The Private Securities Litigation Reform Act of 1995. Without limiting the foregoing, the words "believes," "anticipates," "expects," "potential," and similar expressions are intended to identify forward-looking statements. These forward-looking statements involve known and unknown risks and uncertainties that may cause the Company's actual results, levels of activity, performance or achievements to be materially different from those expressed or implied by these forward-looking statements. Important factors that may cause or contribute to such differences include the timing and success of a commercial launch of VABOMERE in the United States; the Company's broader commercial strategy and competition for VABOMERE; whether additional clinical trials for VABOMERE will advance on a timely basis, or at all, or succeed in achieving their specified endpoints; whether physicians, patients and other key decision makers will accept clinical trial results; whether physicians will prescribe and patients will use VABOMERE, once available; whether the Company will make additional regulatory submissions for VABOMERE on a timely basis, or at all; whether the Company's regulatory submissions will receive approvals from regulatory agencies on a timely basis, or at all; and such other factors as are set forth in the risk factors detailed from time to time in the Company's periodic reports and registration statements filed with the Securities and Exchange Commission, including, without limitation, the risk factors detailed in the Company's Quarterly Report on Form 10-Q filed with the Securities and Exchange Commission on August 9, 2017, which are incorporated herein by reference. The Company specifically disclaims any obligation to update these forward-looking statements.