Safety Profile of Ceftazidime-Avibactam: Pooled Data from the Adult Phase II and Phase III Clinical Trial Programme

Karen Cheng, Paul Newell, Joseph W Chow, Helen Broadhurst, David Wilson, Katrina Yates, Angela Wardman, Karen Cheng, Paul Newell, Joseph W Chow, Helen Broadhurst, David Wilson, Katrina Yates, Angela Wardman

Abstract

Introduction: Ceftazidime-avibactam combines the established anti-pseudomonal cephalosporin, ceftazidime, with the novel non-β-lactam β-lactamase inhibitor, avibactam.

Objectives: The aim of this study was to evaluate the safety of ceftazidime-avibactam in adults using pooled data from two phase II (NCT00690378, NCT00752219) and five phase III (NCT01499290, NCT01726023, NCT01644643, NCT01808093 and NCT01595438/NCT01599806) clinical studies.

Methods: Safety data from seven multicentre, randomised, active-comparator studies were pooled by study group at the patient level for descriptive analyses, comprising patients with complicated urinary tract infection (cUTI), including pyelonephritis, complicated intra-abdominal infection (cIAI), or nosocomial pneumonia (NP), including ventilator-associated pneumonia (VAP), treated with ceftazidime-avibactam ± metronidazole or comparator.

Results: In total, 4050 patients (ceftazidime-avibactam ± metronidazole, n = 2024; comparator, n = 2026) were included in the pooled analysis. Adverse events (AEs) up to the last study visit occurred in 996 (49.2%) and 965 (47.6%) patients treated with ceftazidime-avibactam ± metronidazole and comparator, respectively. The most common AEs across treatment groups were diarrhoea, nausea, headache, vomiting and pyrexia. There were few discontinuations due to AEs (2.5% and 1.7% for ceftazidime-avibactam ± metronidazole and comparators, respectively). Overall rates of serious AEs were 8.7% for ceftazidime-avibactam ± metronidazole and 7.2% for comparators; respective rates of AEs with an outcome of death were 2.0% and 1.8%. AEs considered causally related to the study drug or procedures occurred in 10.7% and 9.6% of patients treated with ceftazidime-avibactam ± metronidazole and comparators; the most common drug-related AEs in both groups were diarrhoea, headache, nausea and increased alanine aminotransferase. No impact to the safety profile of ceftazidime-avibactam ± metronidazole was found with regard to intrinsic factors, such as age or renal function at baseline, or extrinsic factors, such as geographical origin. Potentially clinically significant changes in laboratory parameters were infrequent with no trends or safety concerns identified.

Conclusion: The observed safety profile of ceftazidime-avibactam across infection types is consistent with the established safety profile of ceftazidime monotherapy and no new safety findings were identified. This analysis supports the use of ceftazidime-avibactam as a treatment option in adults with cUTI, cIAI and NP, including VAP.

Trial registration: ClinicalTrials.gov NCT01599806 NCT01499290 NCT01726023 NCT01644643 NCT01595438 NCT01808092.

Conflict of interest statement

All authors except K.Y. were employees of AstraZeneca at the time of the completion of the ceftazidime–avibactam phase III studies and/or during preparation of the manuscript. P.N., J.W.C., H.B., D.W. and A.W. are current or were shareholders in AstraZeneca during the conduct of the ceftazidime–avibactam phase III studies and/or during preparation of the manuscript. K.Y. was a contractor to AstraZeneca at the time of the studies and during manuscript development. K.C. and J.W.C. are currently employees of Pfizer.

Figures

Fig. 1
Fig. 1
Flow chart of patients included in the pooled phase II and III safety analysis (pooled safety population). AE adverse event, cIAI complicated intra-abdominal infection, cUTI complicated urinary tract infection, NP nosocomial pneumonia, SAE serious adverse event. †Patients with cIAI received ceftazidime–avibactam in combination with metronidazole

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