Effects of Teriparatide or Denosumab on Bone in Postmenopausal Women With Osteoporosis

Lilly

Status and phase: Completed; Phase 4

Conditions: Osteoporosis

Treatments: Drug: Denosumab; Drug: Vitamin D; Drug: Demeclocycline; Drug: Teriparatide; Drug: Calcium Supplement; Drug: Tetracycline

Study type: Interventional

Funder types: Industry

Identifiers

NCT01753856

B3D-US-GHDV (Other Identifier)

14592

Details and patient eligibility

About

The purpose of this study is to determine how teriparatide or denosumab affects the bone of postmenopausal women with osteoporosis after 3 months of treatment, as determined by a bone biopsy sample taken from the iliac crest (upper part of the pelvis).

Enrollment: 69 patients

Sex: Female

Ages: 55 to 89 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Ambulatory, postmenopausal women (no vaginal bleeding for at least 2 years prior to screening) with osteoporosis
• Bone mineral density (BMD) T-score of at least -2.5 at femoral neck (FN), total hip (TH), or lumbar spine (LS) (Lumbar vertebrae L1-L4, with at least 2 evaluable vertebrae), with or without atraumatic fracture after menopause, OR
• BMD T-score of at least -1.5 at FN, TH, or LS (L1-L4, with at least 2 evaluable vertebrae), and 1 or more atraumatic fractures after menopause (vertebral or nonvertebral). Nonvertebral fracture sites allowed are wrist, hip, pelvis, rib, humerus, clavicle, leg (femur, tibia, and fibula, excluding ankle)
• Laboratory values for serum calcium, parathyroid hormone (PTH), and alkaline phosphatase must be within the normal reference range

Exclusion criteria

• Has an increased risk of osteosarcoma (bone tumor); this includes Paget's disease of bone, a previous bone tumor, or radiation involving the skeleton
• Has an allergy or intolerance to teriparatide or denosumab and/or is a poor candidate for teriparatide or denosumab treatment (investigator should refer to local product prescribing information)
• Has a history of exposure to DEM or TET therapy in the 12 months prior to screening or a known allergy to DEM or TET
• Has a condition that could put the participant at additional risk of an adverse event (AE) due to the bone biopsy procedure (for example, bleeding disorder)
• Has undergone 2 previous iliac crest bone biopsies (1 in each iliac crest)
• Has a 25-hydroxyvitamin D concentration of <10 nanograms per milliliter (ng/mL)
• Has currently active or suspected (within 1 year prior to enrollment) diseases that affect bone metabolism, other than osteoporosis (such as renal osteodystrophy, hyperthyroidism, osteomalacia, or hyperparathyroidism)
• Has a history of certain cancers within 5 years prior to trial entry
• Current or recent (within 1 year prior to enrollment) celiac disease, inflammatory bowel disease, gastric bypass, or other malabsorption syndrome
• Has significantly impaired hepatic or renal function
• Has had treatment with systemic glucocorticoids in doses ≥5 mg/day prednisone/day or equivalent in the 6 calendar months prior to screening
• Has taken any intravenous osteoporosis medication
• Has had prior treatment with other bisphosphonates and not been off of them for a specific period of time before trial entry
• Has participated in any other clinical trial studying teriparatide, PTH, PTH analog, or denosumab, or prior or current treatment with teriparatide, PTH, PTH analog, or denosumab

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

69 participants in 2 patient groups

Teriparatide

Experimental group

Description:

20 micrograms (µg) teriparatide administered subcutaneously (SC) once every day for 6 months. Demeclocycline (DEM): Beginning 18 days prior to randomization: Days 1, 2, 3 and 16, 17, 18: 150 milligrams (mg) DEM will be taken orally every 6 hours; Days 4 to15: DEM will not be administered. Tetracycline (TET): Beginning 22 days prior to the biopsy procedure: Days 1, 2, 3 and 16, 17, 18: 250 mg TET will be taken orally every 6 hours; Days 4 through 15: TET will not be administered. Calcium: Approximately 1000 milligrams per day (mg/day) administered orally. Vitamin D: Approximately 800 to 1200 International Units per day (IU/day) administered orally.

Treatment:

Drug: Tetracycline

Drug: Calcium Supplement

Drug: Teriparatide

Drug: Demeclocycline

Drug: Vitamin D

Denosumab

Active Comparator group

Description:

60 mg denosumab administered SC once in 6 months. DEM: Beginning 18 days prior to randomization: Days 1, 2, 3 and 16, 17, 18: 150 mg DEM will be taken orally every 6 hours; Days 4 to 15: DEM will not be administered. TET: Beginning 22 days prior to the biopsy procedure: Days 1, 2, 3 and 16, 17, 18: 250 mg TET will be taken orally every 6 hours; Days 4 through 15: TET will not be administered. Calcium: Approximately 1000 mg/day administered orally. Vitamin D: Approximately 800 to 1200 IU/day administered orally.

Treatment:

Drug: Tetracycline

Drug: Calcium Supplement

Drug: Denosumab

Drug: Demeclocycline

Drug: Vitamin D