Use of NPSP558 in the Treatment of Hypoparathyroidism (REPLACE)

This study has been completed.
Information provided by (Responsible Party):
Shire Identifier:
First received: August 8, 2008
Last updated: November 10, 2015
Last verified: March 2015
Use of PTH (1-84) a recombinant hormone in escalating doses for the treatment of adults with hypoparathyroidism. The use of PTH should result in a decrease of calcium and vitamin D supplements.

Condition Intervention Phase
Drug: Placebo
Drug: NPSP558
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study to Investigate the Use of NPSP558, a Recombinant Human Parathyroid Hormone (rhPTH[1-84]) for the Treatment of Adults With Hypoparathyroidism

Resource links provided by NLM:

Further study details as provided by Shire:

Primary Outcome Measures:
  • The Percentage of Subjects Who Met the Triple Efficacy Endpoint Criteria at Week 24. [ Time Frame: Week 24 of dosing ] [ Designated as safety issue: No ]
    The triple efficacy endpoint criteria were defined as at least a 50% reduction from the baseline in oral calcium dose and at least a 50% reduction from the baseline in active vitamin D dose and an albumin-corrected total serum calcium concentration that was maintained or normalized compared to the baseline value (≥ 7.5 mg/dL) and did not exceed the upper limit of the laboratory normal range. The analysis of primary efficacy endpoint was based on investigator prescribed data.

Secondary Outcome Measures:
  • Percentage Changes From Baseline in Daily Calcium Dose at Week 24. [ Time Frame: 24 Weeks ] [ Designated as safety issue: No ]
    The analysis of this endpoint was based on investigator prescribed data.

  • Proportion of Subjects Who Achieved Independence From Active Vitamin D and an Oral Calcium Dose of ≤ 500 mg/Day at Week 24. [ Time Frame: 24 Weeks ] [ Designated as safety issue: No ]
    Subjects Who Achieved Independence from Active Vitamin D Usage and with Calcium Dose of 500 mg/day or less. This analysis was based on Investigator Prescribed Data.

  • Percentage of Subjects With Any Clinical Symptoms of Hypocalcemia During Weeks 16-24. [ Time Frame: 8 Weeks ] [ Designated as safety issue: Yes ]
    Clinical symptoms were a selected group of adverse events that occurred during study weeks 16 through 24. The group of terms were defined by key opinion leaders and documented in study protocol.

Enrollment: 124
Study Start Date: December 2008
Study Completion Date: November 2011
Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Placebo
Sterile water for injection
Drug: Placebo
Placebo for subcutaneous injection
Experimental: 50, 75, 100 mcg NPSP558
Initial dose of 50mcg, to be titrated up to 75mcg and then 100mcg dependent upon response
Drug: NPSP558
Parathyroid hormone 50, 75, or 100 mcg injectable subcutaneously daily

Detailed Description:
Patients with a history of hypoparathyroidism will be randomized to receive placebo or study drug for 24 weeks, which will be injected daily in either thigh. During that time they will be monitored for safety (specifically, calcium levels in the blood and urine). In addition, the patients' intake of Vitamin D and calcium will be measured.

Ages Eligible for Study:   18 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria

Patients who meet all of the following inclusion criteria can be enrolled and potentially randomized into this study:

  • Adult males or females 18 to 85 years of age (prior to screening)
  • History of hypoparathyroidism for ≥ 18 months
  • Requirement for vitamin D metabolite/analog therapy with calcitriol ≥0.25 μg per day or alphacalcidol ≥0.50 μg per day prior to randomization. Requirement for supplemental oral calcium treatment ≥ 1000 mg per day over and above normal dietary calcium intake
  • Serum thyroid function tests within normal laboratory limits at screening
  • Serum magnesium levels within laboratory normal limits
  • Serum 25-hydroxyvitamin D [25(OH)D] level ≤ 1.5-fold the laboratory upper limit of normal
  • Creatinine clearance > 30 mL/min on two separate measurements OR creatinine clearance > 60 mL/min AND serum creatinine < 1.5 mg/dL
  • With regard to female patients: women who are postmenopausal and women who are surgically sterilized can be enrolled. Women of childbearing potential must have a negative pregnancy test at Randomization and be willing to use two medically acceptable methods of contraception for the duration of the study.

Exclusion Criteria

Patients who have any of the following during the screening visit are not eligible for enrollment in this study:

  • Known history of hypoparathyroidism resulting from an activating mutation in the CaSR gene or impaired responsiveness to PTH (pseudohypoparathyroidism)
  • Any disease that might affect calcium metabolism or calcium-phosphate homeostasis other than hypoparathyroidism, such as active hyperthyroidism, Paget's disease, insulin dependent diabetes mellitus (IDDM) or poorly controlled Type II diabetes mellitus (HbA1C > 8%), severe and chronic cardiac, liver or renal disease, Cushing's syndrome, neuromuscular disease such as rheumatoid arthritis, myeloma, pancreatitis, malnutrition, rickets, recent prolonged immobility, active malignancy, primary or secondary hyperparathyroidism, a history of parathyroid carcinoma, hypopituitarism, acromegaly, or multiple endocrine neoplasia types I and II
  • Patients with a history of thyroid cancer must be documented to be disease-free for a period of at least 5 years
  • Patients dependent on regular parenteral calcium infusions (eg calcium gluconate) to maintain calcium homeostasis
  • Patients that have undergone gastric resection or have active peptic ulcer disease requiring medical therapy
  • Use of prohibited medications such as loop and thiazide diuretics, raloxifene hydrochloride, lithium, estrogens and progestins for hormone replacement therapy,methotrexate, or systemic corticosteroids within respective prohibited periods
  • Previous treatment with PTH-like drugs, including PTH(1-84), PTH(1-34) or other N-terminal fragments or analogs of PTH or PTH-related protein within 6 months prior to screening
  • Other drugs known to influence calcium and bone metabolism, such as calcitonin, fluoride tablets, or cinacalcet hydrochloride within the prohibited period
  • Use of oral bisphosphonates within the previous 6 months or IV bisphosphonate preparations within the previous 12 months prior to screening
  • Seizure disorder/epilepsy with a history of a seizure within the previous 6 months prior to screening
  • Presence of open epiphyses
  • Irradiation (radiotherapy) to the skeleton within 5 years
  • Serum 25-hydroxyvitamin D levels greater than 1.5-fold the laboratory upper limit of normal
  • Participation in any other investigational trial in which receipt of investigational drug or device occurred within 6 months prior to screening for this study
  • Pregnant or lactating women
  • History of diagnosed drug or alcohol dependence within the previous 3 years
  • Clinical history of renal calculi within the past 12 months
  • History of gout
  • Disease processes that may adversely affect gastrointestinal absorption, including but not limited to short bowel syndrome, bowel resection, tropical sprue, celiac disease, ulcerative colitis, and Crohn's disease
  • Chronic/severe cardiac disease including but not limited to cardiac insufficiency, arrhythmias, bradycardia (resting heart rate < 60 beats/minute), or hypotension (systolic and diastolic blood pressures < 100 and 60 mmHg, respectively)
  • History of cerebrovascular accident (CVA).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00732615

  Hide Study Locations
United States, Arizona
Mayo Clinic-Scottsdale
Scottsdale, Arizona, United States, 85259
United States, California
Advance Medical Research LLC
Lakewood, California, United States, 90712
Diabetes Associates
Orange, California, United States, 92868
University of California-San Francisco VA Medical Center
San Francisco, California, United States, 94127
United States, Florida
Palm Springs Research Institute
Hialeah, Florida, United States, 33012
Mayo Clinic Jacksonville
Jacksonville, Florida, United States, 32224
United States, Illinois
University of Chicago Medical Center
Chicago, Illinois, United States, 60637
United States, Indiana
Indiana University School of Medicine
Indianapolis, Indiana, United States, 46202
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
United States, Michigan
Michigan Bone and Mineral Clinic PC
Detroit, Michigan, United States, 48236
United States, Minnesota
Mayo Clinic Rochester
Rochester, Minnesota, United States, 55905
United States, New York
Columbia University Medical Center
New York, New York, United States, 10032
University Physicians Group
Staten Island, New York, United States, 10301
United States, North Carolina
Physicians East
Greenville, North Carolina, United States, 27834
United States, Ohio
University of Cincinnati Bone Health and Osteoporosis Center
Cincinnati, Ohio, United States, 45219
United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
United States, Texas
Cetero Research DGD Research Inc.
San Antonio, Texas, United States, 78229
Hillcrest Family Health Center
Waco, Texas, United States, 76708
United States, Washington
The Vancouver Clinic
Vancouver, Washington, United States, 98664
Chetre Hospitalier Universitaire de Liege
Liege, Belgium, BE-4000
Canada, Alberta
Heritage Medical Research Clinic
Calgary, Alberta, Canada, T2N 4Z6
Canada, Nova Scotia
Capital District Health Authority, QEII Health Sciences Centre
Halifax, Nova Scotia, Canada, B3H 2Y9
Canada, Ontario
Oakville Bone Center
Oakville, Ontario, Canada, L6J 1X8
Aarhus University Hospital
Aarhus, Denmark, DK-8000
Odense University Hospital
Odense, Denmark, DK-5000
Hôpital Européen Georges Pompidou
Paris, France, F-75015
Semmelweis University Medical School
Budapest, Hungary
University of Pécs, School of Medicine
Pécs, Hungary
University of Szeged
Szeged, Hungary
University Hospital of Careggi
Firenze, Italy, I - 50134
United Kingdom
Royal Liverpool University Hospital
Liverpool, United Kingdom, L69 3GA
Sponsors and Collaborators
Study Director: Hjalmar Lagast, M.D. NPS Pharma
  More Information

Responsible Party: Shire Identifier: NCT00732615     History of Changes
Other Study ID Numbers: CL1-11-040 
Study First Received: August 8, 2008
Results First Received: February 20, 2015
Last Updated: November 10, 2015
Health Authority: United States: Food and Drug Administration

Keywords provided by Shire:

Additional relevant MeSH terms:
Endocrine System Diseases
Parathyroid Diseases processed this record on May 26, 2016