1688. Omadacycline in Female Adults With Cystitis: Results From a Randomized, Double-Blinded, Adaptive Phase 2 Study
Authors: Overcash J Scott , Tzanis Evan , Manley Amy , Sirbu Alissa , Serio Alisa W , White Tiffany , Wright Kelly , Chitra Surya , Eckburg Paul B 
Published: January 2021

Abstract

Background
In a previous phase 1b study, ≥ 90% of patients with cystitis treated with omadacycline (OMC), a novel intravenous (IV) and oral aminomethylcycline, achieved clinical success. We assessed the safety and efficacy of OMC vs nitrofurantoin (NIT) for treatment of cystitis in a randomized, adaptive phase 2 study.

Methods
Females ≥18 years with uncomplicated symptomatic cystitis were randomized to oral dose regimens of OMC or NIT for 7 days (NCT03425396; Table 1). Efficacy was assessed for noninferiority by investigator’s assessment of clinical response (IACR) at post-treatment evaluation (PTE; primary endpoint; Day 14). Other endpoints included IACR, microbiologic response, and composite clinical and microbiologic response at end of treatment (EOT) and PTE. Treatment-emergent adverse events (TEAEs) were assessed. Results were reviewed by a data monitoring committee.
Table 1

Results
Of 225 patients enrolled, 93.8% completed the study. Baseline (BL) characteristics were similar across groups, except Group 4, which was added late in the study based on blinded review of tolerability. (Table 2). Most patients had moderate BL symptoms of urinary tract infection. Among those with an identified pathogen, the most common species was E. coli. BL minimum inhibitory concentrations (MICs) against E. coli were 0.5 to 8 µg/mL for OMC and &lt; 2 to 64 µg/mL for NIT. Clinical success rates for the intent-to-treat (ITT) population at PTE were high for all groups (OMC 78–88%; NIT 91%; Figure). Microbiologic response rates were higher with NIT vs OMC at PTE (Figure). Noninferiority of OMC to NIT was not met, as the lower limit of the 95% CI for treatment difference exceeded −10% (range −16.8% to −44.1%). OMC was generally well tolerated, with gastrointestinal disorders as the most frequent TEAEs (OMC 22%; NIT 14.8%).
Table 2

Figure

Conclusion
In this phase 2 study, clinical success rates were high in the OMC and NIT groups, although no OMC group met noninferiority criteria. Microbiological responses with all doses of OMC were generally lower than in the NIT group, potentially influenced by the higher BL MICs observed in this study compared with the previous phase 1b study. OMC was well tolerated, with a safety profile consistent with its current labeling. Further analyses are needed to fully understand study outcomes.

Disclosures
J. Scott Overcash, MD, FACEP, Paratek Pharmaceuticals, Inc. (Scientific Research Study Investigator) Evan Tzanis, BS, Paratek Pharmaceuticals, Inc. (Employee, Shareholder) Amy Manley, BS, Paratek Pharmaceuticals, Inc. (Employee) Alissa Sirbu, BSN, Paratek Pharmaceuticals, Inc. (Employee) Alisa W. Serio, PhD, Paratek Pharmaceuticals, Inc. (Employee, Shareholder) Tiffany White, PhD, ContraFact Corporation (Consultant, (ended Feb 2020))Facile Therapeutics (Consultant)Paratek Pharmaceuticals, Inc. (Employee) Kelly Wright, PharmD, Paratek Pharmaceuticals, Inc. (Employee, Shareholder) Surya Chitra, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Paul B. Eckburg, MD, AN2 Therapeutics (Consultant)Bugworks Research (Consultant)Curza (Advisor or Review Panel member)Paratek Pharmaceuticals, Inc. (Consultant)SNIPR Biome (Consultant)Spero Therapeutics (Consultant)