Journal Article

Effect of Cefiderocol, a Siderophore Cephalosporin, on QT/QTc Interval in Healthy Adult Subjects

Narukawa, Yukitoshi, Mason, Jay W., Stanworth, Stephanie H., Katsube, Takayuki, Machida, Mitsuaki, Sanabria, Carlos, Migoya, Elizabeth, Den Nagata, Tsutae

2019

Overview

Cefiderocol is a novel siderophore cephalosporin with potent activity against gram-negative bacteria, including multidrug-resistant strains. This Phase I study was conducted to assess the tolerability of single-ascending doses of cefiderocol (part 1) and the effect of cefiderocol on cardiac repolarization, assessed using the electrocardiographic corrected QT interval (QTcF) and other ECG parameters (part 2), in healthy adult subjects. Part 1 was a randomized, double-blind, placebo-controlled, single-ascending dose study in healthy adult male and female subjects. Part 2 was a 4-period crossover study in which subjects received a single 2-g dose of cefiderocol (therapeutic dose), a single 4-g dose of cefiderocol (supratherapeutic dose), or saline (placebo), each infused over 3 hours, and a single oral 400-mg dose of moxifloxacin. In each treatment period, continuous cardiac monitoring was used to assess the effects of cefiderocol on ECG parameters. The QT interval corrected using the Fridericia formula (QTcF) was the primary ECG parameter; the time-matched placebo- and baseline-adjusted (dd)-QTcF interval was the primary end point. The plasma pharmacokinetic properties of cefiderocol were calculated on the basis of concentration–time profiles in all evaluable subjects. All point estimates for the ddQTcF interval were <5 ms and the upper bound of the 90% CIs were <10 ms at each timepoint after the initiation of the cefiderocol 3-hour infusion. Concentration-effect modeling showed a slightly negative slope and predicted modestly negative values of the ddQTcF interval at the Cmax of cefiderocol. Both doses of cefiderocol were well tolerated. All adverse events were mild in severity, with no deaths or serious adverse events reported. Overall, therapeutic and supratherapeutic doses of cefiderocol had no apparent clinically significant effect on the QTcF.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Anti-Bacterial Agents - pharmacology / Antibiotics / carbapenem resistance / Cefiderocol / Cephalosporins - adverse effects / Cephalosporins - blood / Cephalosporins - pharmacokinetics / Cephalosporins - pharmacology / Cross-Over Studies / Double-Blind Method / Drug dosages / EKG / Electrocardiography - drug effects / Female / Gram-negative bacteria / gram-negative bacterial infection / Healthy Volunteers / Heart / Heart - drug effects / Heart - physiology / Heart Rate - drug effects / Humans / Internal Medicine / Laboratories / Male / Medical Education / Moxifloxacin / Moxifloxacin - pharmacology / Multidrug resistance / Pain / siderophore / Siderophores - adverse effects / Siderophores - blood / Siderophores - pharmacokinetics / Siderophores - pharmacology / Young Adult