Imipenem/Relebactam/Cilastatin Versus Piperacillin/Tazobactam for Treatment of Participants With Bacterial Pneumonia (MK-7655A-014) (RESTORE-IMI 2)

• ClinicalTrials.gov Identifier: NCT02493764
• Recruitment Status: Completed
• First Posted: July 9, 2015
• Results First Posted: April 16, 2020
• Last Update Posted: April 16, 2020
• Sponsor: Merck Sharp & Dohme LLC
• Information provided by (Responsible Party): Merck Sharp & Dohme LLC

Tracking Information

• First Submitted Date: July 7, 2015
• First Posted Date: July 9, 2015
• Results First Submitted Date: April 3, 2020
• Results First Posted Date: April 16, 2020
• Last Update Posted Date: April 16, 2020
• Actual Study Start Date: November 24, 2015
• Actual Primary Completion Date: April 3, 2019 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: April 3, 2020)

Percentage of Participants With All-cause Mortality (ACM) Through Day 28 in the Modified Intention-to-treat (MITT) Population [ Time Frame: Up to 28 days ]

The percentage of participants in the MITT population with mortality due to any cause from randomization through Day 28 was determined for each arm.

• Original Primary Outcome Measures (submitted: July 7, 2015): Percentage of participants surviving at Day 28 [ Time Frame: Day 28 ]

Current Secondary Outcome Measures (submitted: April 3, 2020)

• Percentage of Participants in the MITT Population With a Favorable Clinical Response (FCR) at Early Follow-up (EFU) Visit [ Time Frame: Up to 16 days after end of therapy (up to 30 days) ]
  The percentage of participants with a FCR at EFU was determined for each arm. Favorable clinical response at EFU was defined as either "sustained cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] with no evidence of resurgence and no additional antibiotics are required) or "cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] and no additional antibiotics are required).
• Percentage of Participants With ≥1 Adverse Event (AE) [ Time Frame: Up to 30 days ]
  An AE is defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment.
• Percentage of Participants Discontinuing Study Therapy Due to an AE [ Time Frame: Up to 14 days ]
  An AE is defined as any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment.
• Percentage of Participants With ACM in the Microbiological Modified Intention-to-treat (mMITT) Population [ Time Frame: Up to 28 days ]
  The percentage of participants in the mMITT population with mortality due to any cause from randomization through Day 28 was determined for each arm.
• Percentage of Participants With ACM at EFU in the MITT Population [ Time Frame: Up to 16 days after end of therapy (up to 30 days) ]
  The percentage of participants in the MITT population with mortality due to any cause from randomization through EFU was determined for each arm.
• Percentage of Participants With ACM at EFU in the mMITT Population [ Time Frame: Up to 16 days after end of therapy (up to 30 days) ]
  The percentage of participants in the mMITT population with mortality due to any cause from randomization through EFU was determined for each arm.
• Percentage of Participants in the Clinically Evaluable (CE) Population With a FCR at On-therapy Visit 1 (OTX1) [Day 3] [ Time Frame: Day 3 (OTX1) ]
  The percentage of participants with a FCR at OTX1 was determined for each arm. Favorable clinical response at OTX1 was defined as "improved" (majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"]).
• Percentage of Participants in the CE Population With a FCR at OTX2 (Day 6) [ Time Frame: Day 6 (OTX2) ]
  The percentage of participants with a FCR at OTX2 was determined for each arm. Favorable clinical response at OTX2 was defined as "improved" (majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"]).
• Percentage of Participants in the CE Population With a FCR at OTX3 (Day 10) [ Time Frame: Day 10 (OTX3) ]
  The percentage of participants with a FCR at OTX3 was determined for each arm. Favorable clinical response at OTX3 was defined as "improved" (majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"]).
• Percentage of Participants in the CE Population With a FCR at EOT Visit [ Time Frame: From Day 7 to Day 14 ]
  The percentage of participants with a FCR at EOT was determined for each arm. Favorable clinical response at EOT was defined as either "cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] and no additional antibiotics are required) or "improved" (the majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"] and no additional antibiotics are required).
• Percentage of Participants in the CE Population With a FCR at Day 28 [ Time Frame: Day 28 ]
  The percentage of participants with a FCR at Day 28 was determined for each arm. Favorable clinical response at Day 28 was defined as either "sustained cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] with no evidence of resurgence and no additional antibiotics are required) or "cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] and no additional antibiotics are required).
• Percentage of Participants in the CE Population With a FCR at EFU Visit [ Time Frame: Up to 16 days after end of therapy (up to Day 30) ]
  The percentage of participants with a FCR at EFU was determined for each arm. Favorable clinical response at EFU was defined as either "sustained cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] with no evidence of resurgence and no additional antibiotics are required) or "cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] and no additional antibiotics are required).
• Percentage of Participants in the MITT Population With a FCR at OTX1 (Day 3) [ Time Frame: Day 3 (OTX1) ]
  The percentage of participants with a FCR at OTX1 was determined for each arm. Favorable clinical response at OTX1 was defined as "improved" (majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"]).
• Percentage of Participants in the MITT Population With a FCR at OTX2 (Day 6) [ Time Frame: Day 6 (OTX2) ]
  The percentage of participants with a FCR at OTX2 was determined for each arm. Favorable clinical response at OTX2 was defined as "improved" (majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"]).
• Percentage of Participants in the MITT Population With a FCR at OTX3 (Day 10) [ Time Frame: Day 10 (OTX3) ]
  The percentage of participants with a FCR at OTX3 was determined for each arm. Favorable clinical response at OTX3 was defined as "improved" (majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"]).
• Percentage of Participants in the MITT Population With a FCR at EOT [ Time Frame: From Day 7 to Day 14 ]
  The percentage of participants with a FCR at EOT was determined for each arm. Favorable clinical response at EOT was defined as either "cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] and no additional antibiotics are required) or "improved" (the majority of pre-therapy signs and symptoms of the index infection have improved or resolved [or returned to "pre-infection status"] and no additional antibiotics are required).
• Percentage of Participants in the MITT Population With a FCR at Day 28 [ Time Frame: Day 28 ]
  The percentage of participants with a FCR at Day 28 was determined for each arm. Favorable clinical response at Day 28 was defined as either "sustained cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] with no evidence of resurgence and no additional antibiotics are required) or "cure" (all pre-therapy signs and symptoms of the index infection have resolved [or returned to "pre-infection status"] and no additional antibiotics are required).
• Percentage of Participants in the mMITT Population With a Favorable Microbiological Response (FMR) at End of Treatment (EOT) Visit [ Time Frame: From Day 7 to Day 14 ]
  The percentage of participants with a FMR at EOT was determined for each arm. Favorable microbiological response at EOT was defined as either "eradication" (a lower respiratory tract culture taken at EOT showing eradication of baseline pathogen) or "presumed eradication" (no specimen collected because the participant deemed clinically cured or improved).
• Percentage of Participants in the mMITT Population With a FMR at EFU Visit [ Time Frame: Up to 16 days after end of therapy (up to Day 30) ]
  The percentage of participants with a FMR at EFU was determined for each arm. Favorable microbiological response at EOT was defined as either "eradication" (a lower respiratory tract culture taken at EFU showing eradication of baseline pathogen) or "presumed eradication" (no specimen collected because the participant deemed clinically cured or improved).
• Percentage of Participants in the Microbiologically Evaluable (ME) Population With a FMR at EOT Visit [ Time Frame: From Day 7 to Day 14 ]
  The percentage of participants with a FMR at EOT was determined for each arm. Favorable microbiological response at EOT was defined as either "eradication" (a lower respiratory tract culture taken at EOT showing eradication of baseline pathogen) or "presumed eradication" (no specimen collected because the participant deemed clinically cured or improved).
• Percentage of Participants in the ME Population With a FMR at EFU Visit [ Time Frame: Up to 16 days after end of therapy (up to Day 30) ]
  The percentage of participants with a FMR at EOT was determined for each arm. Favorable microbiological response at EOT was defined as either "eradication" (a lower respiratory tract culture taken at EOT showing eradication of baseline pathogen) or "presumed eradication" (no specimen collected because the participant deemed clinically cured or improved).

• Original Secondary Outcome Measures (submitted: July 7, 2015): Percentage of participants with a favorable clinical response at early follow up visit [ Time Frame: Up to 16 days after end of therapy (up to Day 30) ]
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: Imipenem/Relebactam/Cilastatin Versus Piperacillin/Tazobactam for Treatment of Participants With Bacterial Pneumonia (MK-7655A-014)
• Official Title: A Phase III, Randomized, Double-Blind, Active Comparator-Controlled Clinical Trial to Study the Safety, Tolerability, and Efficacy of Imipenem/Cilastatin/Relebactam (MK-7655A) Versus Piperacillin/Tazobactam in Subjects With Hospital-Acquired Bacterial Pneumonia or Ventilator-Associated Bacterial Pneumonia
• Brief Summary: This study aims to compare treatment with a fixed-dose combination (FDC) of imipenem/relebactam/cilastatin (IMI/REL) with a FDC of piperacillin/tazobactam (PIP/TAZ) in participants with hospital-acquired or ventilator-associated bacterial pneumonia (HABP or VAPB, respectively). The primary hypothesis is that IMI/REL is non-inferior to PIP/TAZ in the incidence rate of all-cause mortality.
• Detailed Description: Not Provided
• Study Type: Interventional
• Study Phase: Phase 3
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Double (Participant, Investigator); Primary Purpose: Treatment
• Condition: Bacterial Pneumonia

Intervention

• Drug: Imipenem
  Imipenem 500 mg as part of a FDC administered by IV every 6 hours for a minimum of 7 days, up to 14 days
• Drug: Relebactam
  Relebactam 250 mg as part of a FDC administered by IV every 6 hours for a minimum of 7 days, up to 14 days
• Drug: Cilastatin
  Cilastatin 500 mg as part of a FDC administered by IV every 6 hours for a minimum of 7 days, up to 14 days
• Drug: Piperacillin
  Piperacillin 4000 mg as part of a FDC administered by IV every 6 hours for a minimum of 7 days, up to 14 days
• Drug: Tazobactam
  Tazobactam 500 mg as part of a FDC administered by IV every 6 hours for a minimum of 7 days, up to 14 days
• Drug: Linezolid
  Linezolid 600 mg administered open-label by IV every 12 hours for up to 14 days

Study Arms

• Experimental: IMI/REL
  Imipenem 500 mg + relebactam 250 mg + cilastatin 500 mg as a FDC administered intravenously (IV) every 6 hours for a minimum of 7 days, up to 14 days. At study entry open label linezolid 600 mg will also be administered by IV every 12 hours for up to 14 days.
  Interventions:

  • Drug: Imipenem
  • Drug: Relebactam
  • Drug: Cilastatin
  • Drug: Linezolid
• Active Comparator: PIP/TAZ
  Piperacillin 4000 mg + tazobactam 500 mg as a FDC administered IV every 6 hours for a minimum of 7 days, up to 14 days. At study entry open label linezolid 600 mg will also be administered by IV every 12 hours for up to 14 days.
  Interventions:

  • Drug: Piperacillin
  • Drug: Tazobactam
  • Drug: Linezolid

Publications *

• Patel M, Bellanti F, Daryani NM, Noormohamed N, Hilbert DW, Young K, Kulkarni P, Copalu W, Gheyas F, Rizk ML. Population pharmacokinetic/pharmacodynamic assessment of imipenem/cilastatin/relebactam in patients with hospital-acquired/ventilator-associated bacterial pneumonia. Clin Transl Sci. 2022 Feb;15(2):396-408. doi: 10.1111/cts.13158. Epub 2021 Oct 27.
• Titov I, Wunderink RG, Roquilly A, Rodriguez Gonzalez D, David-Wang A, Boucher HW, Kaye KS, Losada MC, Du J, Tipping R, Rizk ML, Patel M, Brown ML, Young K, Kartsonis NA, Butterton JR, Paschke A, Chen LF. A Randomized, Double-blind, Multicenter Trial Comparing Efficacy and Safety of Imipenem/Cilastatin/Relebactam Versus Piperacillin/Tazobactam in Adults With Hospital-acquired or Ventilator-associated Bacterial Pneumonia (RESTORE-IMI 2 Study). Clin Infect Dis. 2021 Dec 6;73(11):e4539-e4548. doi: 10.1093/cid/ciaa803.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: April 15, 2019): 537
• Original Estimated Enrollment (submitted: July 7, 2015): 536
• Actual Study Completion Date: April 3, 2019
• Actual Primary Completion Date: April 3, 2019 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• Requires treatment with IV antibiotic therapy for hospital-acquired bacterial pneumonia (HABP) or ventilator-associated bacterial pneumonia (VABP)
• Fulfills clinical and radiographic criteria, with onset of criteria occurring after more than 48 hours of hospitalization or within 7 days after discharge from a hospital (for HABP); or at least 48 hours after mechanical ventilation (for VABP)
• Has an adequate baseline lower respiratory tract specimen obtained for Gram stain and culture
• Has an infection known or thought to be caused by microorganisms susceptible to the IV study therapy
• Agrees to allow any bacterial isolates obtained from protocol-required specimens related to the current infection to be provided to the Central Microbiology Reference Laboratory for study-related microbiological testing, long term storage, and other future testing
• Is not of reproductive potential; or if of reproductive potential agrees to avoid impregnating a partner or avoid becoming pregnant, by practicing abstinence or using acceptable contraception

Exclusion Criteria:

• Has a baseline lower respiratory tract specimen Gram stain that shows the presence of Gram-positive cocci only
• Has confirmed or suspected community-acquired bacterial pneumonia (CABP)
• Has confirmed or suspected pneumonia of viral, fungal or parasitic origin
• Has HABP/VABP caused by an obstructive process, including lung cancer or other known obstruction
• Has a carcinoid tumor or carcinoid syndrome
• Has active immunosuppression defined as either receiving immunosuppressive medications or having a medical condition associated with immunodeficiency
• Is expected to survive for less than 72 hours
• Has a concurrent condition or infection that would preclude evaluation of therapeutic response
• Has received effective antibacterial drug therapy for the index infection of HABP/VABP for more than 24 hours continuously, during the previous 72 hours
• Has a history of serious allergy, hypersensitivity or a serious reaction to any penicillin or beta-lactamase inhibitors
• Female is pregnant, expecting to conceive, is breastfeeding or plans to breastfeed
• Has a history of seizure disorder requiring ongoing prior treatment with anti-convulsive therapy within the last 3 years
• Anticipates treatment with the following: valproic acid or divalproex sodium, serotonin re-uptake inhibitors, tricyclic antidepressants, or serotonin receptor antagonists, meperidine, buspirone, concomitant systemic antibacterial agents, antifungal or antiviral therapy for the index infection of HABP/VABP
• Is currently undergoing hemodialysis or peritoneal dialysis
• Is currently participating in, has participated in during the previous 30 days, or anticipates to participate in any other clinical study involving the administration of experimental medication
• Has previously participated in this study

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Not Provided
• Removed Location Countries: Argentina, Australia, Brazil, Bulgaria, Canada, Colombia, Croatia, Czechia, Estonia, France, Georgia, Germany, Guatemala, Italy, Japan, Korea, Republic of, Latvia, Lithuania, Mexico, Norway, Peru, Philippines, Portugal, Romania, Russian Federation, Serbia, Spain, Turkey, Ukraine, United States

Administrative Information

• NCT Number: NCT02493764
• Other Study ID Numbers: 7655A-014; 2015-000246-34 ( EudraCT Number ); 163240 ( Registry Identifier: JAPIC-CTI ); MK-7655A-014 ( Other Identifier: Merck Protocol Number )
• Has Data Monitoring Committee: Yes
• U.S. FDA-regulated Product: Not Provided

IPD Sharing Statement

• Plan to Share IPD: Yes
• Plan Description: http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
• URL: http://engagezone.msd.com/ds_documentation.php

• Current Responsible Party: Merck Sharp & Dohme LLC
• Original Responsible Party: Same as current
• Current Study Sponsor: Merck Sharp & Dohme LLC
• Original Study Sponsor: Same as current
• Collaborators: Not Provided

Investigators

• Study Director: Medical Director; Merck Sharp & Dohme LLC

• PRS Account: Merck Sharp & Dohme LLC
• Verification Date: March 2020