A Trial Investigating the Safety, Tolerability and Efficacy of TransCon PTH Administered Daily in Adults With Hypoparathyroidism (PaTHway)

• ClinicalTrials.gov Identifier: NCT04701203
• Recruitment Status: Active, not recruiting
• First Posted: January 8, 2021
• Last Update Posted: April 6, 2022
• Sponsor: Ascendis Pharma Bone Diseases A/S
• Information provided by (Responsible Party): Ascendis Pharma A/S ( Ascendis Pharma Bone Diseases A/S )

Study Description

Brief Summary:

During the first 26 weeks of the trial, participants will be randomly assigned to one of two groups: one group will receive TransCon PTH and one group will receive placebo. All subjects will start with a fixed dose of study drug and will be individually and progressively titrated to an optimal dose over a 10 week period, followed by an individualized dosing period up to 16 weeks. TransCon PTH or placebo will be administered as a subcutaneous injection using a pre-filled injection pen. Neither trial participants nor their doctors will know who has been assigned to each group. After the 26 weeks, participants will continue in the trial as part of a long-term extension study. During the extension, all participants will receive TransCon PTH, with the dose adjusted to their individual needs. This is a global trial that will be conducted in, but not limited to, the United States, Canada, Germany, and Denmark.

Condition or disease	Intervention/treatment	Phase
Hypoparathyroidism; Endocrine System Diseases; Parathyroid Diseases	Combination Product: TransCon PTH; Combination Product: Placebo	Phase 3

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 82 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Double-blind, placebo controlled, parallel group with subjects randomized into two treatment groups (3:1): TransCon PTH at a starting dose of 18 mcg/day, and placebo for TransCon PTH
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: PaTHway TRIAL: A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Trial, With an Open-Label Extension, Investigating the Safety, Tolerability and Efficacy of TransCon PTH Administered Subcutaneously Daily in Adults With Hypoparathyroidism
• Actual Study Start Date: February 16, 2021
• Actual Primary Completion Date: January 12, 2022
• Estimated Study Completion Date: January 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: TransCon PTH; TransCon PTH at a starting dose of 18 mcg delivered once daily by subcutaneous injection	Combination Product: TransCon PTH; TransCon PTH drug product is supplied as a solution with a concentration of 0.3 mg PTH(1-34)/mL in a single-patient-use prefilled pen intended for subcutaneous injection.
Placebo Comparator: Placebo; Placebo for TransCon PTH delivered once daily by subcutaneous injection	Combination Product: Placebo; Placebo is supplied as a solution containing the formulation buffer for TransCon PTH in a single-patient-use prefilled pen intended for subcutaneous injection.

Outcome Measures

Primary Outcome Measures :

1. Efficacy - Primary endpoint [ Time Frame: 26 weeks ]
   The proportion of subjects with albumin-adjusted sCa within the normal range, and independence from active vitamin D, and independence from therapeutic doses of calcium (i.e., taking calcium supplements ≤600 mg/day), and no increase in prescribed study drug within 4 weeks prior to Week 26 visit

Secondary Outcome Measures :

1. Change from baseline in HPES Symptom - Physical Domain score [ Time Frame: 26 weeks ]
   Change from baseline in Hypoparathyroidism Patient Experience Scale (HPES) Symptom - Physical Domain score, a disease-specific patient reported outcome, at 26 weeks of treatment
2. Change from baseline in HPES Symptom - Cognitive Domain score [ Time Frame: 26 weeks ]
   Change from baseline in Hypoparathyroidism Patient Experience Scale (HPES) Symptom - Cognitive Domain score, a disease-specific patient reported outcome, at 26 weeks of treatment
3. Change from baseline in HPES Impact - Physical Functioning Domain score [ Time Frame: 26 weeks ]
   Change from baseline in Hypoparathyroidism Patient Experience Scale (HPES) Impact - Physical Functioning Domain score, a disease-specific patient reported outcome, at 26 weeks of treatment
4. Change from baseline in HPES Impact - Daily Life Domain score [ Time Frame: 26 weeks ]
   Change from baseline in Hypoparathyroidism Patient Experience Scale (HPES) Impact - Daily Life Domain score, a disease-specific patient reported outcome, at 26 weeks of treatment
5. Change from baseline in SF-36 Physical Functioning subscale score [ Time Frame: 26 weeks ]
   Change from baseline in the 36-item Short Form Survey (SF-36) Physical Functioning subscale score, a generic health survey, at 26 weeks of treatment

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Males and females, ≥18 years of age
2. Subjects with postsurgical chronic HP, or auto-immune, genetic, or idiopathic HP for at least 26 weeks. Diagnosis of HP is established based on historic hypocalcemia in the setting of inappropriately low serum PTH levels

3. Requirement for doses of SoC (e.g., calcitriol, alfacalcidol, calcium supplements) at or above a minimum threshold:

   • For countries other than Japan: requirement for a dose of calcitriol ≥0.5 μg/day, or alfacalcidol ≥1.0 μg/day and (elemental) calcium ≥800 mg/day (e.g., calcium citrate, calcium carbonate etc.) for at least 12 weeks prior to Screening. In addition, the dose of calcitriol, or alfacalcidol, or calcium should be stable for at least 5 weeks prior to Screening
   • For Japan: requirement for a dose of calcitriol ≥1.0 μg/day, or alfacalcidol ≥2.0 μg/day for at least 12 weeks prior to Screening. In addition, the dose of calcitriol or alfacalcidol should be stable for at least 5 weeks prior to Screening. In Japan only (due to local practice and dietary patterns), there is no requirement to exceed a minimum dose of calcium supplements

4. Optimization of supplements prior to randomization to achieve the target serum levels of:

   • 25(OH) vitamin D levels of 20-80 ng/mL (49-200 nmol/L) and
   • Magnesium level in the normal range, or just below the normal range and
   • Albumin-adjusted or ionized sCa level in the normal range, or just below the normal range
5. The subject demonstrates a 24-hour uCa excretion of ≥125 mg/24h (on a sample collected within 52 weeks prior to Screening or during the Screening Period)
6. BMI 17- 40 kg/m2 at Screening
7. If ≤25 years of age, radiological evidence of epiphyseal closure based on X-ray of nondominant wrist and hand
8. Thyroid-stimulating hormone (TSH) within normal laboratory limits within the 6 weeks prior to Visit 1; if on suppressive therapy for a history of thyroid cancer, TSH level must be ≥0.2 mIU/mL
9. If treated with thyroid hormone replacement therapy, the dose must have been stable for at least 5 weeks prior to Screening
10. eGFR ≥30 mL/min/1.73 m2 during Screening
11. Able to perform daily subcutaneous self-injections of study drug (or have a designee to perform injections) via a pre-filled injection pen
12. Able and willing to provide written and signed informed consent in accordance with GCP

Exclusion Criteria:

1. Impaired responsiveness to PTH (pseudohypoparathyroidism) which is characterized as PTH-resistance, with elevated PTH levels in the setting of hypocalcemia
2. Any disease that might affect calcium metabolism or calcium-phosphate homeostasis or PTH levels other than HP, such as active hyperthyroidism; Paget disease of bone; severe hypomagnesemia; type 1 diabetes mellitus or poorly controlled type 2 diabetes mellitus (HbA1C >9%, documented HbA1C result drawn within 12 weeks prior to Screening is acceptable); severe and chronic liver, or renal disease; Cushing syndrome; multiple myeloma; active pancreatitis; malnutrition; rickets; recent prolonged immobility; active malignancy (other than low-risk well differentiated thyroid cancer or basal cell skin cancer); active hyperparathyroidism; parathyroid carcinoma within 5 years prior to Screening; acromegaly; or multiple endocrine neoplasia types 1 and 2
3. High risk thyroid cancer within 2 years, requiring suppression of TSH <0.2 mIU/mL
4. Use of loop diuretics, phosphate binders (other than calcium supplements), digoxin, lithium, methotrexate, biotin >30 μg/day, or systemic corticosteroids (other than as replacement therapy)
5. Use of thiazide diuretic within 4 weeks prior to the 24-hour urine collection scheduled to occur within 1 week prior to Visit 1
6. Use of PTH-like drugs (whether commercially available or through participation in an investigational trial), including PTH(1-84), PTH(1-34), or other N-terminal fragments or analogs of PTH or PTH-related protein, within 4 weeks prior to Screening
7. Use of other drugs known to influence calcium and bone metabolism, such as calcitonin, fluoride tablets (>0.5 mg/day), strontium, or cinacalcet hydrochloride, within 12 weeks prior to Screening
8. Use of osteoporosis therapies known to influence calcium and bone metabolism, i.e., bisphosphonate (oral or intravenous [IV]), denosumab, raloxifene, or romosozumab therapies within 2 years prior to Screening
9. Non-hypocalcemic seizure disorder with a history of a seizure within 26 weeks prior to Screening
10. Increased risk for osteosarcoma, such as those with Paget's disease of bone or unexplained elevations of alkaline phosphatase, hereditary disorders predisposing to osteosarcoma, or with a prior history of substantial external beam or implant radiation therapy involving the skeleton
11. Pregnant or lactating women
12. Male who has a female partner who intends to become pregnant or is of childbearing potential and is unwilling to use adequate contraceptive methods during the trial
13. Diagnosed drug or alcohol dependence within 3 years prior to Screening
14. Disease processes that adversely affect gastrointestinal absorption, including but not limited to short bowel syndrome, significant small bowel resection, gastric bypass, tropical sprue, active celiac disease, active ulcerative colitis, active Crohn's disease, gastroparesis and AIRE gene mutations with malabsorption
15. Chronic or severe cardiac disease within 26 weeks prior to Screening including but not limited to congestive heart failure, myocardial infarction, severe or uncontrolled arrhythmias, bradycardia (resting heart rate <48 beats/minute, unless chronic and asymptomatic), symptomatic hypotension or systolic BP <80 mm Hg or diastolic <40 mm Hg or poorly controlled hypertension (systolic BP >165 mm Hg or diastolic >95 mm Hg). In the absence of a prior history of hypertension, an isolated BP >165/95 in the setting of white coat hypertension/anxiety may not be exclusionary and a measurement can be repeated prior to randomization
16. Cerebrovascular accident within 5 years prior to Screening
17. Within 26 weeks prior to Screening: acute colic due to nephrolithiasis, or acute gout. Subjects with asymptomatic renal stones are permitted
18. Participation in any other interventional trial in which receipt of investigational drug or device occurred within 8 weeks (or within 5.5 times the half-life of the investigational drug (whichever comes first) prior to Screening
19. Any disease or condition that, in the opinion of the investigator, may require treatment or make the subject unlikely to fully complete the trial, or any condition that presents undue risk from the investigational product or procedures, including treated malignancies that are likely to recur within the approximate 3.5-year duration of the trial
20. Known allergy or sensitivity to PTH or any of the excipients [metacresol, mannitol, succinic acid, NaOH/(HCl)]
21. Likely to be non-compliant with respect to trial conduct
22. Any other reason that in the opinion of the investigator would prevent the subject from completing participation or following the trial schedule

Contacts and Locations

Locations

United States, California

Ascendis Pharma Investigational Site

San Francisco, California, United States, 94143

United States, Illinois

Ascendis Pharma Investigational Site

Chicago, Illinois, United States, 60637

United States, Minnesota

Ascendis Pharma Investigational Site

Rochester, Minnesota, United States, 55905

United States, Nevada

Ascendis Pharma Investigational Site

Reno, Nevada, United States, 89511

United States, New York

Ascendis Pharma Investigational Site

New York, New York, United States, 10032

United States, North Carolina

Ascendis Pharma Investigational Site

Greenville, North Carolina, United States, 27834

United States, Texas

Ascendis Pharma Investigational Site

Austin, Texas, United States, 78731

Ascendis Pharma Investigational Site

Fort Worth, Texas, United States, 76132

United States, Washington

Ascendis Pharma Investigational Site

Spokane, Washington, United States, 99204

Canada, Nova Scotia

Ascendis Pharma Investigational Site

Halifax, Nova Scotia, Canada, B3H 2Y9

Canada, Ontario

Ascendis Pharma Investigational Site

Oakville, Ontario, Canada, L6M 1M1

Canada, Quebec

Ascendis Pharma Investigational Site

Québec, Quebec, Canada, G1V 4G2

Denmark

Ascendis Pharma Investigational Site

København, Hovedstaden, Denmark, 2100

Ascendis Pharma Investigational Site

Aarhus, Midtjylland, Denmark, 8200

Germany

Ascendis Pharma Investigational Site

Dresden, Sachsen, Germany, 01307

Hungary

Ascendis Pharma Investigational Site

Szeged, Csongrad, Hungary, 6720

Ascendis Pharma Investigational Site

Budapest, Hungary, 1083

Italy

Ascendis Pharma Investigational Site

Bologna, Emilia-Romagna, Italy, 40138

Ascendis Pharma Investigational Site

Roma, Lazio, Italy, 00128

Ascendis Pharma Investigational Site

Pisa, Piacenza, Italy, 56126

Norway

Ascendis Pharma Investigational Site

Oslo, Norway, 0176

Sponsors and Collaborators

Ascendis Pharma Bone Diseases A/S

Investigators

• Study Director: Aimee D Shu, MD; Ascendis Pharma A/S North American Medical Monitor/Medical Expert
• Study Director: Michael Beckert, MD; Ascendis Pharma A/S European Medical Monitor/Medical Expert

More Information

• Responsible Party: Ascendis Pharma Bone Diseases A/S
• ClinicalTrials.gov Identifier: NCT04701203
• Other Study ID Numbers: TCP-304; 2020-003380-26 ( EudraCT Number )
• First Posted: January 8, 2021
• Last Update Posted: April 6, 2022
• Last Verified: March 2022

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

Keywords provided by Ascendis Pharma A/S ( Ascendis Pharma Bone Diseases A/S ):

Hypoparathyroidism; Parathyroid Hormone; TransCon PTH; PTH(1-34); Prodrug; Sustained Release; Parathyroid Hormone Replacement Therapy

Additional relevant MeSH terms:

Hypoparathyroidism; Endocrine System Diseases; Parathyroid Diseases