Early Effects of Abaloparatide on Tissue-Based Indices of Bone Formation and Resorption

• ClinicalTrials.gov Identifier: NCT03710889
• Recruitment Status: Completed
• First Posted: October 18, 2018
• Results First Posted: October 15, 2021
• Last Update Posted: October 15, 2021
• Sponsor: Radius Health, Inc.
• Information provided by (Responsible Party): Radius Health, Inc.

Study Description

Brief Summary:

The objective of this study is to measure the early effects of abaloparatide on tissue-based bone formation using samples obtained by transiliac crest bone biopsy after quadruple fluorochrome labeling.

Condition or disease	Intervention/treatment	Phase
Osteoporosis, Postmenopausal; Osteoporosis; Osteoporosis Vertebral; Osteoporosis Risk; Osteoporosis Fracture; Osteoporosis Localized to Spine; Osteoporosis, Age-Related; Osteoporosis Senile; Osteoporosis of Vertebrae	Drug: Abaloparatide	Phase 3

Detailed Description:

This was an open-label, single-arm study of postmenopausal women with osteoporosis treated with 80 micrograms (μg) abaloparatide for 3 months. Transiliac bone biopsies were taken at 3 months after quadruple fluorochrome labeling. The treatment duration of 3 months was determined to be the optimal time when biochemical markers of bone turnover peak and are predictive of subsequent changes in bone mineral density (BMD).

The main study was conducted for a 3-month treatment period with a 1-month follow up. A sub-study was conducted at 1 site to collect peripheral quantitative computed tomography (pQCT) data. Study treatment for participants in the sub-study was extended for an additional 3 months of study drug administration for a total of 6 months of treatment.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 23 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: An Open-Label, Single-Arm, Multicenter Study to Evaluate the Early Effects of Abaloparatide on Tissue-Based Indices of Bone Formation and Resorption
• Actual Study Start Date: September 20, 2018
• Actual Primary Completion Date: July 15, 2020
• Actual Study Completion Date: July 15, 2020

Arms and Interventions

Arm	Intervention/treatment
Experimental: Abaloparatide; Participants self-administered a single daily dose of 80 micrograms (µg) of abaloparatide subcutaneously (SC) during the treatment period. Participants were instructed to use a new injection pen after each 30-day period.	Drug: Abaloparatide; Abaloparatide is a novel, synthetic, 34 amino acid peptide designed to be a potent and selective activator of the PTH/PTH-related protein (PTHrP) type 1 receptor (PTHR1) signaling pathway with 41% homology to PTH[1-34] and 76% homology to human PTHrP[1-34].; Other Names: TYMLOS®; BA058

Outcome Measures

Primary Outcome Measures :

1. Change From Baseline in Mineralizing Surface/Bone Surface (MS/BS) in the Cancellous Envelope at Month 3 [ Time Frame: Baseline (Day 1), Month 3 ]
   Change in dynamic histomorphometry indices was assessed in the cancellous envelope.

Secondary Outcome Measures :

1. Change From Baseline in Bone Formation Rate/Bone Surface (BFR/BS) in the Cancellous Envelope at Month 3 [ Time Frame: Baseline (Day 1), Month 3 ]
   Change in dynamic histomorphometry indices was assessed in the cancellous envelope. BFR/BS was reported as cubic millimeter/square millimeter/year (mm^3/mm^2/year).
2. Change in Serum Procollagen Type I N-terminal Propeptide (s-P1NP) From Baseline at Month 1 and Month 3 [ Time Frame: Baseline (Day 1), Months 1 and 3 ]
   Blood samples were taken to measure efficacy related markers of bone metabolism at Day 1, Month 1, and Month 3.
3. Change in Serum Carboxy-Terminal Cross-Linking Telopeptide of Type I Collagen (s-CTX) From Baseline at Month 1 and Month 3 [ Time Frame: Baseline (Day 1), Months 1 and 3 ]
   Blood samples were taken to measure efficacy-related markers of bone metabolism at Day 1, Month 1, and Month 3.

Eligibility Criteria

• Ages Eligible for Study: 50 Years to 85 Years (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria

Participants must meet all of the following criteria to be eligible to participate in this study:

1. The participant is a healthy ambulatory postmenopausal female from 50 to 85 years of age (inclusive) with osteoporosis.
2. The participant has been postmenopausal for at least 5 years. Postmenopausal status will be established by a history of amenorrhea for at least 5 years and by an elevated follicle stimulating hormone (FSH) value of ≥30 international units(IU)/liter (L).
3. The participant has a BMD T-score ≤-2.5 at the lumbar spine (L1-L4) or hip (femoral neck or total hip) by dual-energy x-ray absorptiometry (DXA) or lumbar spine or hip BMD T-score ≤-2.0 with a history of low trauma vertebral, forearm, humerus, sacral, pelvic, hip, femoral, or tibial fracture sustained within 5 years prior to enrollment. These fractures must be documented by radiograph or hospital report.
4. The participant is in good general health as determined by medical history and physical examination (including vital signs), has a body mass index (BMI) of 18.5 to 33, inclusive, and is without evidence of clinically significant abnormality in the opinion of the Investigator.
5. The participant has serum calcium (albumin-corrected), parathyroid hormone (PTH) (1-84), phosphorus, and alkaline phosphatase levels all within the normal range during the Screening Period. Any participant with an elevated alkaline phosphatase value, and who meets all other entry criteria, is required to have a normal bone-specific alkaline phosphatase result to be enrolled.
6. The participant has serum 25-hydroxyvitamin D values ≥ 20 nanograms (ng)/milliliter (mL) and within the normal range. Participants with serum 25-hydroxyvitamin D levels < 20 ng/ml may be treated with vitamin D3 and re-tested once.
7. The participant's resting 12-lead electrocardiogram (ECG) obtained during screening shows no clinically significant abnormality.
8. The participant has read, understood, and signed the written informed consent form.

Exclusion Criteria:

Participants with any of the following characteristics are not eligible to participate in the study:

1. Presence of abnormalities of the lumbar spine that would prohibit assessment of lumbar spine BMD, defined as having at least 2 radiologically evaluable vertebrae within L1-L4.
2. Unevaluable hip BMD or participants who have undergone bilateral hip replacement (unilateral hip replacement is acceptable).
3. History of bone disorders (for example, Paget's disease) other than postmenopausal osteoporosis.
4. Clinically significant abnormality of serum hemoglobin, hematocrit, white blood cells (WBC) and platelets, coagulation, or usual serum chemistry: electrolytes, renal function, liver function and serum proteins.
5. Unexplained elevation of serum alkaline phosphatase.
6. History of radiotherapy (radiation therapy), other than radioiodine.
7. History of bleeding disorder that would preclude a bone biopsy, in the opinion of the Investigator.
8. History of chronic or recurrent renal, hepatic, pulmonary, allergic, cardiovascular, gastrointestinal, endocrine, central nervous system, hematologic or metabolic diseases, or immunologic, emotional and/or psychiatric disturbances to a degree that would interfere with the interpretation of study data or compromise the safety of the participant.
9. History of Cushing's disease, hyperthyroidism, hypo- or hyperparathyroidism, or malabsorptive syndromes within the past year.
10. History of significantly impaired renal function (serum creatinine > 177 micromoles [µmol]/L or >2.0 milligrams [mg]/deciliter [dL]). If the serum creatinine is >1.5 and ≤ 2.0 mg/dL, the calculated creatinine clearance (Cockcroft-Gault) must be ≥ 30 mL/minute (min).
11. History of any cancer within the past 5 years (other than basal cell or squamous cell cancer of the skin).
12. History of osteosarcoma at any time or a history of hereditary disorders which could predispose the participant to osteosarcoma.
13. History of nephrolithiasis or urolithiasis within the past 5 years.
14. Participant known to be positive for hepatitis B, hepatitis C, or human immunodeficiency virus infection (HIV-1 or HIV-2). Testing is not required in the absence of clinical signs and symptoms suggestive of HIV infection or acute or chronic hepatitis.

Contacts and Locations

Locations

United States, Colorado

Panorama Orthopedics & Spine Center

Golden, Colorado, United States, 80401

United States, Georgia

Center for Advanced Research & Education

Gainesville, Georgia, United States, 30501

United States, Massachusetts

Harvard Medical School

Boston, Massachusetts, United States, 02114

United States, Michigan

Henry Ford Health System

Detroit, Michigan, United States, 48230

Sponsors and Collaborators

Radius Health, Inc.

Investigators

• Study Director: Medical Director; Radius Health, Inc.

  Study Documents (Full-Text)

Documents provided by Radius Health, Inc.:

Study Protocol  [PDF] November 5, 2018

Statistical Analysis Plan  [PDF] March 5, 2020

More Information

Publications:

Hattersley G, Dean T, Corbin BA, Bahar H, Gardella TJ. Binding Selectivity of Abaloparatide for PTH-Type-1-Receptor Conformations and Effects on Downstream Signaling. Endocrinology. 2016 Jan;157(1):141-9. doi: 10.1210/en.2015-1726. Epub 2015 Nov 12.

Cosman F, Miller PD, Williams GC, Hattersley G, Hu MY, Valter I, Fitzpatrick LA, Riis BJ, Christiansen C, Bilezikian JP, Black D. Eighteen Months of Treatment With Subcutaneous Abaloparatide Followed by 6 Months of Treatment With Alendronate in Postmenopausal Women With Osteoporosis: Results of the ACTIVExtend Trial. Mayo Clin Proc. 2017 Feb;92(2):200-210. doi: 10.1016/j.mayocp.2016.10.009.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Dempster DW, Zhou H, Rao SD, Recknor C, Miller PD, Leder BZ, Annett M, Ominsky MS, Mitlak BH. Early Effects of Abaloparatide on Bone Formation and Resorption Indices in Postmenopausal Women With Osteoporosis. J Bone Miner Res. 2021 Apr;36(4):644-653. doi: 10.1002/jbmr.4243. Epub 2021 Jan 28.

• Responsible Party: Radius Health, Inc.
• ClinicalTrials.gov Identifier: NCT03710889
• Other Study ID Numbers: BA058-05-020
• First Posted: October 18, 2018
• Results First Posted: October 15, 2021
• Last Update Posted: October 15, 2021
• Last Verified: October 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Radius Health, Inc.:

BA058; abaloparatide; TYMLOS®; Bone metabolism; Osteoporosis; Fracture; Bone loss

Additional relevant MeSH terms:

Osteoporosis; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Fractures, Bone; Wounds and Injuries; Bone Diseases, Metabolic; Bone Diseases; Musculoskeletal Diseases; Metabolic Diseases; Abaloparatide; Bone Density Conservation Agents; Physiological Effects of Drugs