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54th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC®) Washington, D.C. 5-9 September 2014 ICAAC Presentation Guide The Medicines Company's purpose is to save lives, alleviate suffering and contribute to the economics of healthcare by focusing on 3000 leading acute/intensive care hospitals worldwide. Its vision is to be a leading provider of solutions in three areas: serious infectious disease care, acute cardiovascular care and surgery and perioperative care. The company operates in the Americas, Europe and the Middle East, and Asia Pacific regions with global centers today in Parsippany, NJ, USA and Zurich, Switzerland. The Medicines Company is positioned to address the complex problems associated with multi-drug resistant infections. The research projects, development programs, and marketed products span the spectrum of infections caused by gram-positive bacteria including MRSA, and gram-negative infections including Acinetobacter, carbapenem-resistant Enterobacteriaceae and other dangerous multi-drugresistant pathogens. The investigational product pipeline includes CarbavanceTM (meropenem/ RPX7009), RPX-602 (a new formulation of MINOCIN® (minocycline) for injection), and a pre-clinical developmental program of novel investigational agents. ORBACTIV™ and MINOCIN® are two antibiotics approved for use in the US. The product portfolio has the potential to offer clinicians and patients a suite of innovative new antibiotic approaches to tackle many of the most vexing problems in infectious disease today. A total of 19 presentations describing the clinical and nonclinical data of ORBACTIV and Carbavance will be delivered during ICAAC. ORBACTIV – 11 presentations Carbavance – 8 presentations Complete versions of the abstracts are available at the ICAAC website ORBACTIV™ (oritavancin) for Injection ORBACTIV (oritavancin) for injection is indicated for the treatment of adult patients with acute bacterial skin and skin structure infections (ABSSSI) caused by susceptible isolates of the following Gram-positive microorganisms: Staphylococcus aureus (including methicillin-susceptible and methicillin–resistant isolates), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus anginosus group (includes S. anginosus, S. intermedius, and S. constellatus), and Enterococcus faecalis (vancomycin-susceptible isolates only). ORBACTIV is the first and only singledose antibiotic approved for commercial use in the US. The EMA accepted for review the Marketing Authorization Application (MAA) for ORBACTIV in Q1 2014, for which the Company is seeking approval for the treatment of complicated skin and soft tissue infections (cSSTI). Please see Important Safety Information for ORBACTIV below. Eleven abstracts evaluating efficacy, safety, microbiology and pharmacokinetics/ pharmacodynamics will be presented. Presentation Number Session Title Presentation Title Authors Session Type Location Date/Time F-973 Glycopeptides and Conjugates Efficacy and Safety Outcomes by Subgroups in Studies of a Single Dose of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections (ABSSSI) G.R. Corey, S. Good, H. Jiang, G. Moeck, M. Wikler Poster Exhibit Hall B 7 Sept 2014; 11:00– 13:00 F-972 Glycopeptides and Conjugates Concordance Between Early and Late Clinical Response with a Single Dose of Oritavancin in the SOLO Studies G.R. Corey, S. Good, H. Jiang, G. Moeck, M. Wikler for the SOLO I and SOLO II investigators Poster Exhibit Hall B 7 Sept 2014; 11:00– 13:00 F-961 Glycopeptides and Conjugates Comparison of Oritavancin (ORI) In vitro Susceptibility of Staphylococcus aureus (SA) isolates from Phase 3 Studies for Acute Bacterial Skin and Skin-structure Infections and from a Surveillance Study in the US and Europe F.F. Arhin, G. Moeck, D.F. Sahm Poster Exhibit Hall B 7 Sept 2014; 11:00– 13:00 C-825 Susceptibility to newer anti Grampositive molecules In Vitro Activity of Oritavancin (ORI) and Key Comparators Against Gram-Positive Pathogens Isolated from the USA and Europe: 2011–2013 M. Hackel, T. Lynch, G. Moeck, F.F. Arhin, D.F Sahm Poster Exhibit Hall B 7 Sept 2014; 11:00– 13:00 2014 ICAAC Presentation Guide The Medicines Company Page 2 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts. Presentation Number Session Title Presentation Title Authors Session Type Location Date/Time C-823 Susceptibility to newer anti Grampositive molecules Oritavancin activity against Gram-positive pathogens responsible for documented infections in US hospitals (2012–2013) R. E. Mendes, D. J. Farrell, H. S. Sader, P. R. Rhomberg, R. N. Jones Poster Exhibit Hall B 7 Sept 2014; 11:00– 13:00 C-824 Susceptibility to newer anti Grampositive molecules In Vitro Activity of Oritavancin against GramPositive Pathogens Isolated in Canadian Hospitals from 2011 to 2013 J. A. Karlowsky, H. Adam, M. Baxter, B. Weshnoweski, R. Vashisht, D. Hoban and G. G. Zhanel Poster Exhibit Hall B 7 Sept 2014; 11:00– 13:00 L-1725 Clinical Studies in Skin and Skin Structure Infections Microbiological Responses by Pathogen in Phase 3 Studies of Single Dose Oritavancin for Acute Bacterial Skin and Skin Structure Infection (ABSSSI) G. Moeck, F. F. Arhin, H. Jiang, C. Fiset Poster Exhibit Hall B 8 Sept 2014; 11:00– 13:00 2014 ICAAC Presentation Guide The Medicines Company Page 3 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts. Presentation Number Session Title Presentation Title Authors Session Type Location Date/Time A-1309 Clinical Pharmacology and therapeutic drug monitoring of Vancomycin and newer Lipoglycopeptides/Li popeptides Oritavancin (ORI) PharmacokineticPharmacodynamic (PK-PD) Analyses for Efficacy Based on Data from Patients with Acute BacterialSkin and Skin Structure Infections (ABSSSI) Enrolled in SOLO I and II S.M. Bhavnani, J.P. Hammel, C.M. Rubino, G. Moeck, H. Jiang, S.E. Bellibas, P.G. Ambrose Poster Exhibit Hall B 8 Sept 2014; 11:00– 13:00 A-1308 Clinical Pharmacology and therapeutic drug monitoring of Vancomycin and newer Lipoglycopeptides/Li popeptides Population Pharmacokinetic (PPK) Analysis for Oritavancin (ORI) Based on Data from Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI) C.M. Rubino, S.M. Bhavnani, G. Moeck, S.E. Bellibas, P.G. Ambrose Poster Exhibit Hall B 8 Sept 2014; 11:00– 13:00 L-1729 Clinical Studies in Skin and Skin Structure Infections Efficacy And Safety Of Single Dose Oritavancin Compared To 7-10 Days Of Vancomycin In Patients With Acute Bacterial Skin And Skin Structure Infections Treated In The Outpatient Setting K. LaPensee K, W. Fan, H.Jiang, T. Lodise Poster Exhibit Hall B 8 Sept 2014; 11:00– 13:00 A-1307 Clinical Pharmacology and therapeutic drug monitoring of Vancomycin and newer Lipoglycopeptides/Li popeptides The Effects of Supratherapeutic Dose of Oritavancin on ECG intervals: A thorough QT Study in Healthy Volunteers S.E. Bellibas, N.Y Huang, B. Darpo, C. Sanabria, K. Fusaro, S. Good, J. Mason Poster Exhibit Hall B 8 Sept 2014; 11:00– 13:00 2014 ICAAC Presentation Guide The Medicines Company Page 4 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts. Carbavance™ (meropenem/ RPX7009) Carbavance (meropenem/ RPX7009), an investigational agent not approved for commercial use in any market, is a combination of meropenem and RPX7009 administered as a fixed combination by IV infusion and is being developed to treat serious gram-negative infections, such as cUTIs, including those infections caused by bacteria resistant to currently available carbapenems. Carbavance was designed to address gram-negative bacteria that produce new beta-lactamase enzymes that have spread in the US and Europe, including strains producing the Klebsiella pneumoniae carbapenemase (KPC) enzyme. KPC-producing bacteria are the predominant form of carbapenemresistant Enterobacteriaceae (CRE) in the US and are classified by the CDC to be an urgent antimicrobial resistance threat. The FDA has designated Carbavance as a Qualified Infectious Disease Product (QIDP). The QIDP designation provides Carbavance priority review by the FDA, eligibility for the FDA's "fast track" status, and an additional five years of any non-patent exclusivity upon approval of the product for intravenous use in six indications. These include complicated urinary tract and intra-abdominal infections, hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia, and febrile neutropenia. The QIDP designation was granted pursuant to the Generating Antibiotic Incentives Now (GAIN) Act, included in the FDA Safety and Innovation Act (FDASIA) that was signed into law in 2012. Eight abstracts reporting on Phase 1 safety and pharmacokinetics, microbiology and pharmacokinetics/ pharmacodynamics will be presented. Presentation Number Session Title Presentation Title Authors Session Type Location Date/Time C-103 009-I'll take Potpouri for 1000, Alex Characterization of Mutants Selected In Vitro Using Sub-optimal Exposures of Meropenem Alone and With RPX7009 D. Sun, D. Rubio-Aparicio, M. N. Dudley and O. Lomovskaya Poster Exhibit Hall B 6 Sept 2014; 12:00–14:00 C-777 Ceftaroline and New Beta-Lactam/BetaLactamase Inhibitor Combinations: The Real Efficacy Effect of the β-lactamase inhibitor RPX7009 combined with meropenem tested against a large collection of KPCproducing Enterobacteriaceae M. Castanheira, H.K. Becker, P.R. Rhomberg, R.N. Jones Poster Exhibit Hall B 7 Sept 2014; 11:00–13:00 2014 ICAAC Presentation Guide The Medicines Company Page 5 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts. Presentation Number Session Title Presentation Title Authors Session Type Location Date/Time C-1193 New Insights into the Beta-Lactamase Inhibitors Combination Losing My Resistance: Loss of KPC Following Exposure of KPCProducing Strains of Klebsiella pneumonia to Carbapenems in Combination with RPX7009 D. Sun, D. Rubio-Aparicio, D. Griffith, M. N. Dudley, O. Lomovskaya Talk Room 207 B 7 Sept 2014; 15:00–17:00 C-1194 New Insights into the Beta-Lactamase Inhibitors Combination The Effect of Trp105 Substitutions in KPC on Interactions with the Novel Beta-lactamase Inhibitor RPX7009 R. Tsivkovsky and O. Lomovskaya Talk Room 207 B 7 Sept 2014; 15:00–17:00 F-960 Beta-Lactamase inhibitors: Defeating bacterial defenses A Phase 1 Study of the Safety, Tolerability, and Pharmacokinetics of a Single dose of the Beta-lactamase inhibitor RPX7009 Alone, Meropenem Alone, and both in Combination (Carbavance) in Healthy Adult Subjects D. C. Griffith, M. Rubino, J. S. Loutit, E. E. Morgan, D. White, M. N. Dudley Poster Exhibit Hall B 7 Sept 2014; 11:00–13:00 F-959 Beta-Lactamase inhibitors: Defeating bacterial defenses Efficacy of Simulated Human Exposures of Carbavance (MeropenemRPX7009) against Carbapenem-resistant Enterobacteriaceae in an In Vitro Hollow Fiber Model Z. Tarazi, M. Sabet, D. Rubio-Aparicio, T. Nolan, J. Parkinson, O. Lomovskaya, M.N. Dudley, D.C. Griffith Poster Exhibit Hall B 7 Sept 2014; 11:00–13:00 2014 ICAAC Presentation Guide The Medicines Company Page 6 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts. Presentation Number Session Title Presentation Title Authors Session Type Location Date/Time F-958 Beta-Lactamase inhibitors: Defeating bacterial defenses In Vivo Efficacy of Carbavance (meropenem/RPX7009) against KPC-producing Enterobacteriaceae M. Sabet, Z. Tarazi, T. Nolan, J. Parkinson, D. Rubio-Aparicio, O. Lomovskaya, M.N. Dudley, D. C. Griffith Poster Exhibit Hall B 7 Sept 2014; 11:00–13:00 F-938 Beta-Lactamase inhibitors: Defeating bacterial defenses Meropenem/RPX7009 MIC Quality Control Ranges Using CLSI MultiLaboratory M23-A3 Study Design J.E. Ross, M. Castanheira, R. K. Flamm, R.N. Jones Poster Exhibit Hall B 7 Sept 2014; 11:00–13:00 2014 ICAAC Presentation Guide The Medicines Company Page 7 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts. ORITAVANCINTM (oritavancin) for Injection IMPORTANT SAFETY INFORMATION Contraindications Use of intravenous unfractionated heparin sodium is contraindicated for 48 hours after ORBACTIV administration because the activated partial thromboplastin time (aPTT) test results are expected to remain falsely elevated for approximately 48 hours after ORBACTIV administration. ORBACTIV is contraindicated in patients with known hypersensitivity to ORBACTIV. Warnings and Precautions Concomitant warfarin use: Co-administration of ORBACTIV and warfarin may result in higher exposure of warfarin, which may increase the risk of bleeding. Use ORBACTIV in patients on chronic warfarin therapy only when the benefits can be expected to outweigh the risk of bleeding. Coagulation test interference: ORBACTIV has been shown to artificially prolong aPTT for up to 48 hours, and may prolong PT and INR for up to 24 hours. Hypersensitivity reactions have been reported with the use of antibacterial agents including ORBACTIV. Discontinue infusion if signs of acute hypersensitivity occur. Monitor closely patients with known hypersensitivity to glycopeptides. Infusion-related reactions have been reported. Slow the rate or interrupt infusion if infusion reaction develops. Clostridium difficile-associated colitis: Evaluate patients if diarrhea occurs. Osteomyelitis: Institute appropriate alternate antibacterial therapy in patients with confirmed or suspected osteomyelitis. Prescribing ORBACTIV in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Adverse Reactions The most common adverse reactions (≥ 3%) in patients treated with ORBACTIV were headache, nausea, vomiting, limb and subcutaneous abscesses, and diarrhea. Please see www.orbactiv.com for the full prescribing information. Forward-Looking Statements Statements contained in this ICAAC presentation guide about The Medicines Company that are not purely historical, and all other statements that are not purely historical, may be deemed to be forwardlooking statements for purposes of the safe harbor provisions under The Private Securities Litigation Reform Act of 1995. Without limiting the foregoing, the words "believes," "anticipates" "expects" and “potential” and similar expressions, are intended to identify forward-looking statements. These forwardlooking statements involve known and unknown risks and uncertainties that may cause the Company's actual results, levels of activity, performance or achievements to be materially different from those expressed or implied by these forward-looking statements. Important factors that may cause or contribute to such differences include the extent of the commercial success of the Company’s products, the Company's ability to develop its global operations and penetrate foreign markets, whether the Company's products will advance in the clinical trials process on a timely basis or at all, whether the Company will make regulatory submissions for product candidates on a timely basis, whether its regulatory submissions will receive approvals from regulatory agencies on a timely basis or at all, whether physicians, patients and other key decision makers will accept clinical trial results and such other factors as are set forth in the risk factors detailed from time to time in the Company's periodic reports and registration statements filed with the Securities and Exchange Commission including, without limitation, the risk factors detailed in the Company's Quarterly Report on Form 10-Q filed with the SEC on August 4, 2014, which are incorporated herein by reference. The Company specifically disclaims any obligation to update these forward-looking statements. 2014 ICAAC Presentation Guide The Medicines Company Page 8 This ICAAC Presentation Guide is intended as reference information for U.S. investors and analysts.