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Single-Dose Pharmacokinetics and Safety of Meropenem-Vaborbactam in Subjects with Chronic Renal Impairment.
- Source :
-
Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2018 Feb 23; Vol. 62 (3). Date of Electronic Publication: 2018 Feb 23 (Print Publication: 2018). - Publication Year :
- 2018
-
Abstract
- Vaborbactam is a member of a new class of β-lactamase inhibitors with inhibitory activity against serine carbapenemases (e.g., Klebsiella pneumoniae carbapenemase) that has been developed in combination with meropenem. The pharmacokinetics of the combination was evaluated in 41 subjects with chronic renal impairment in a phase 1, open-label, single-dose study. Subjects were assigned to one of five groups based on renal function: normal (creatinine clearance of ≥90 ml/min), mild (estimated glomerular filtration rate [eGFR] of 60 to 89 ml/min/1.73 m <superscript>2</superscript> ), moderate (eGFR of 30 to <60), or severe (eGFR of <30) impairment plus end-stage renal disease (ESRD) patients on hemodialysis. Subjects received a single intravenous dose of 1 g of meropenem plus 1 g of vaborbactam by 3-h infusion. The ESRD group received two doses (on and off dialysis) separated by a washout. Pharmacokinetic parameters were estimated by standard noncompartmental methods. For both meropenem and vaborbactam, the area under the concentration-time curve was larger and the elimination half-life was longer with decreasing renal function. Meropenem and vaborbactam total plasma clearance (CLt) rates were similar and decreased with decreasing renal function. Slopes of the linear relationship between eGFR and CLt were similar, indicating a similar proportional reduction in CLt with decreasing renal function. Hemodialysis significantly increased drug clearance of meropenem (mean of 2.21-fold increase in CLt, P < 0.001) and vaborbactam (mean of 5.11-fold increase, P = 0.0235) relative to drug administration off dialysis, consistent with dose recovery rates of 38.3% and 52.9% for meropenem and vaborbactam, respectively, in dialysate. Plasma clearance of meropenem and vaborbactam is reduced with renal impairment, requiring dose adjustment. Hemodialysis removes both drugs. (This study has been registered at ClinicalTrials.gov under identifier NCT02020434.).<br /> (Copyright © 2018 American Society for Microbiology.)
- Subjects :
- Adult
Aged
Anti-Bacterial Agents blood
Anti-Bacterial Agents urine
Area Under Curve
Boronic Acids blood
Boronic Acids urine
Creatinine blood
Drug Administration Schedule
Drug Combinations
Female
Glomerular Filtration Rate physiology
Half-Life
Humans
Injections, Intravenous
Kidney Failure, Chronic physiopathology
Kidney Failure, Chronic therapy
Kidney Failure, Chronic urine
Male
Meropenem blood
Meropenem urine
Middle Aged
Renal Insufficiency, Chronic physiopathology
Renal Insufficiency, Chronic therapy
Renal Insufficiency, Chronic urine
Anti-Bacterial Agents pharmacokinetics
Boronic Acids pharmacokinetics
Kidney Failure, Chronic blood
Meropenem pharmacokinetics
Renal Dialysis
Renal Insufficiency, Chronic blood
Subjects
Details
- Language :
- English
- ISSN :
- 1098-6596
- Volume :
- 62
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Antimicrobial agents and chemotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 29311069
- Full Text :
- https://doi.org/10.1128/AAC.02103-17