Panel Backs Shionogo Urinary Tract Infection Drug

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FDA’s Antimicrobial Drugs Advisory Committee has voted 14 to 2 to recommend approval of a Shionogi NDA for cefiderocol injection for its proposed indication to treat complicated urinary tract infections (cUTI). Cefiderocol is a siderophore cephalosporin with shown activity against several gram-negative bacteria.

 

Briefing materials released in advance of the meeting noted a “finding of increased mortality in the CREDIBLE-CR study in the overall risk benefit considerations for cefiderocol.” Panel members were not persuaded by the finding to rule negatively against the drug. Most members agreed that, if approved, product labeling should clearly identify all safety issues, including any increased mortality risk. Some members also recommended that the agency include in the labeling a recommendation to monitor liver function.

 

FDA’s briefing materials said that while the safety and efficacy of cefiderocol have been demonstrated for the treatment of cUTI, “higher mortality in cefiderocol-treated patients was observed in a trial in critically ill patients with a variety of infections due to carbapenem-resistant organisms... While no specific reason for the imbalance in mortality could be identified, it appears that some of the deaths were related to progression of infection/lack of clinical response and were more common in patients with infections due to organisms such as A. baumannii, S. maltophilia, and P. aeruginosa. Whether this difference in mortality is a chance finding or truly reflects a deficit in the activity of cefiderocol in critically ill patients is unclear.”

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