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FDA Approves MiddleBrook's Amoxicillin PULSYS
for Pharyngitis/Tonsillitis in Adolescents and Adults
GERMANTOWN, Md.
January 24, 2008
MiddleBrook Pharmaceuticals, Inc. (Nasdaq: MBRK),
a pharmaceutical company focused on developing and commercializing
novel anti-infective products, today announced that it has received
approval of its New Drug Application (NDA) from the U.S. Food and
Drug Administration (FDA), for its once-daily MOXATAG(TM) Tablets
775 mg (amoxicillin extended-release tablets) for the treatment
of adults and pediatric patients 12 years and older with pharyngitis
and/or tonsillitis secondary to Streptococcus pyogenes (commonly
referred to as strep throat).
The FDA approval was based on results
from a Phase 3 clinical study conducted with more than 600 patients
that found once-daily MOXATAG
for 10 days was effective in eradicating bacteria responsible
for strep throat and demonstrated statistical non-inferiority to
a four
times daily dose of penicillin for 10 days. MOXATAG was very well
tolerated in the clinical trial.
"We are extremely gratified to have received FDA approval
of our MOXATAG NDA," stated Edward Rudnic, Ph.D., president
and CEO of MiddleBrook. "As the first and only once-daily amoxicillin
therapy approved for marketing in the United States, we believe
MOXATAG represents a major advance for patients and doctors seeking
safe, effective, and convenient treatment options for strep throat.
We now look forward to continuing our ongoing strategic evaluation
process from a position of greater strength with this approval in
hand."
In accordance with the requirements of the Pediatric
Research Equity Act, MiddleBrook has agreed with the FDA to
further evaluate its
MOXATAG product candidate for pediatric patients less than 12
years of age with pharyngitis and/or tonsillitis as part of a post-marketing
commitment. The Company has agreed to submit a completed study
report
and data set for MOXATAG in pediatric patients less than 12 years
old within the next five years as part of this commitment.
"Compared to four times daily penicillin, once-daily MOXATAG
has shown comparable efficacy and tolerability in eradicating Group
A streptococcal infections of the pharynx. However, the once-daily
dosing of MOXATAG is a major advantage," said lead study investigator
Stan L. Block, M.D., professor of clinical pediatrics at the Universities
of Louisville and Kentucky Medical Schools. "For the first
time, physicians in the U.S. have the option of an FDA-approved
once-daily amoxicillin therapy to treat their adolescent and adult
patients with pharyngitis/tonsillitis. This should ensure better
first- line therapy compliance with a penicillin class of antibiotic."
Clinical
Trial Results Summary
The approval of MOXATAG was based on MiddleBrook's
Phase 3 clinical study of more than 600 adults and pediatric patients
12 years and
older in a double- blind, double-dummy, randomized, parallel-group,
50-center non-inferiority trial. The Company compared its MOXATAG
tablet for the treatment of pharyngitis/tonsillitis due to Streptococcus
pyogenes (Group A streptococcus) delivered in a once-daily, 775
milligram tablet for a period of 10 days to 250 milligrams of penicillin
dosed four times daily, for a total of one gram per day, for 10
days.
Bacteriological eradication at the post-therapy
test-of-cure visit in the per-protocol population was 85.0 percent
(198/233)
of patients
with MOXATAG and 83.4 percent (191/229) with penicillin. These
results demonstrate statistical non-inferiority (95 percent confidence
interval
of -5.1, 8.2). The per-protocol patient population included patients
with confirmed Group A streptococcal infections, who were compliant
with treatment and did not have major protocol violations. Other
results from the trial were consistent with the per-protocol population,
with MOXATAG therapy demonstrating statistical non-inferiority
to the comparator therapy in all primary and secondary endpoints.
Important
Safety Information
MOXATAG is indicated for the treatment of tonsillitis
and/or pharyngitis secondary to Streptococcus pyogenes in adults
and pediatric patients
12 years or older.
MOXATAG is contraindicated in patients with known
serious hypersensitivity to amoxicillin or to other drugs in
the same class or in patients
who have demonstrated anaphylactic reactions to beta-lactams.
Serious
and occasionally fatal hypersensitivity (anaphylactic) reactions
have been reported in patients on penicillin therapy.
These reactions are more likely to occur in individuals with a
history of penicillin hypersensitivity and/or a history of sensitivity
to
multiple allergens. Before initiating therapy with MOXATAG, careful
inquiry should be made concerning previous hypersensitivity reactions
to penicillins, cephalosporins, or other allergens. If an allergic
reaction occurs, MOXATAG should be discontinued and appropriate
therapy instituted.
Clostridium difficile associated diarrhea (CDAD)
has been reported with nearly all antibacterial agents, including
amoxicillin, and
may range in severity from mild diarrhea to fatal colitis. CDAD
must be considered in all patients who present with diarrhea following
antibiotic use. Careful medical history is necessary since CDAD
has been reported to occur over two months after the administration
of antibacterial agents. If CDAD is suspected or confirmed, ongoing
antibiotic use not directed against C. difficile may need to be
discontinued.
In a controlled U.S. clinical trial, the majority
of treatment-emergent adverse reactions were of a mild and transient
nature. The most
frequently reported adverse reactions (> 1%) which were suspected
or probably drug- related were vaginal yeast infection (2.0%),
diarrhea (1.7%), nausea (1.3%), and headache (1.0%).
Safety and
effectiveness of MOXATAG in pediatric patients less
than 12 years of age has not been established.
About MOXATAG(TM):
MOXATAG (amoxicillin extended-release
tablets) is a once-a-day extended- release formulation of amoxicillin
for oral administration
consisting of three components: one immediate-release and two delayed-release.
The three components are combined in a specific ratio to prolong
the release of amoxicillin from MOXATAG compared to immediate-release
amoxicillin.
MOXATAG is intended to provide a lower treatment
dose, once-daily alternative to currently approved penicillin and
amoxicillin
regimens
for the treatment of adults and pediatric patients 12 years and
older with tonsillitis and/or pharyngitis. MiddleBrook utilized
its proprietary PULSYS(R) once-daily pulsatile delivery technology
to develop MOXATAG. The company currently has a total of 26 issued
U.S. patents and two issued foreign patents covering its PULSYS
technology. Patents specifically relating to MOXATAG run to 2020.
Amoxicillin
is indicated for a broad range of infections, and is commonly
prescribed as a first-line therapy for common infections
such as otitis media (middle ear infection), pharyngitis (sore
throat), and sinusitis (sinus infection). Group A streptococcus,
the primary
bacteria causing pharyngitis, have been uniformly susceptible
to amoxicillin and have not developed resistance to the penicillins,
despite the long-term use of amoxicillin for pharyngitis.
According
to data from IMS Health, a pharmaceutical research company, approximately
one-quarter of amoxicillin prescriptions are written
for pharyngitis, strep throat, and tonsillitis in adults and children.
Approximately 60 million prescriptions for amoxicillin were written
in 2006 with total retail sales of more than $650 million. For
pediatricians, amoxicillin is the most prescribed drug among all
therapeutic classes.
Among family physicians, amoxicillin is the twelfth most prescribed
drug among all therapeutic classes.
The most commonly prescribed
treatment for the management of Group A streptococcal pharyngitis
is 500 milligrams of amoxicillin dosed
three-times daily for a period of 10 days. With the FDA approval
of MOXATAG, physicians now have available the first once-daily
product in the aminopenicillin class for the treatment of pharyngitis
while
utilizing approximately one-half the amount of amoxicillin currently
used.
About pharyngitis/tonsillitis:
Pharyngitis is a
painful inflammation of the throat caused by a variety of microorganisms,
both viral and bacterial. About 15 million
patients annually seek relief of sore throat symptoms in the United
States. The most common bacterial cause of acute pharyngitis is
Streptococcus pyogenes, or Group A streptococcus, which is referred
to as "strep throat." Symptoms of strep throat include
fever, painful swallowing, swelling of the throat, and headache.
Symptomatic strep throat can lead to complications, such as rheumatic
fever, and should be treated with antibiotic therapy. Pharyngitis
ranks in the top ten diagnoses made by pediatricians, family physicians,
and emergency medicine specialists.
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