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Effect of denosumab on bone density and turnover in postmenopausal women with low bone mass after long-term continued, discontinued, and restarting of therapy: a randomized blinded phase 2 clinical trial.
- Source :
-
Bone [Bone] 2008 Aug; Vol. 43 (2), pp. 222-229. Date of Electronic Publication: 2008 Apr 26. - Publication Year :
- 2008
-
Abstract
- Introduction: Denosumab is a fully human monoclonal antibody that inhibits receptor activator of nuclear factor-kappa B ligand (RANKL), an essential mediator of osteoclast formation, function, and survival that has been shown to decrease bone turnover and increase bone mineral density (BMD) in treated patients. We assessed the long-term efficacy and safety of denosumab, and the effects of discontinuing and restarting denosumab treatment in postmenopausal women with low bone mass.<br />Methods: Postmenopausal women with a lumbar spine T-score of -1.8 to -4.0 or proximal femur T-score of -1.8 to -3.5 were randomized to denosumab every 3 months (Q3M; 6, 14, or 30 mg) or every 6 months (Q6M; 14, 60, 100, or 210 mg); placebo; or open-label oral alendronate weekly. After 24 months, patients receiving denosumab either continued treatment at 60 mg Q6M for an additional 24 months, discontinued therapy, or discontinued treatment for 12 months then re-initiated denosumab (60 mg Q6M) for 12 months. The placebo cohort was maintained. Alendronate-treated patients discontinued alendronate and were followed. Changes in BMD and bone turnover markers (BTM) as well as safety outcomes were evaluated.<br />Results: Overall, 262/412 (64%) patients completed 48 months of study. Continuous, long-term denosumab treatment increased BMD at the lumbar spine (9.4% to 11.8%) and total hip (4.0% to 6.1%). BTM were consistently suppressed over 48 months. Discontinuation of denosumab was associated with a BMD decrease of 6.6% at the lumbar spine and 5.3% at the total hip within the first 12 months of treatment discontinuation. Retreatment with denosumab increased lumbar spine BMD by 9.0% from original baseline values. Levels of BTM increased upon discontinuation and decreased with retreatment. Adverse event rates were similar among treatment groups.<br />Conclusions: In postmenopausal women with low BMD, long-term denosumab treatment led to gains in BMD and reduction of BTM throughout the course of the study. The effects on bone turnover were fully reversible with discontinuation and restored with subsequent retreatment.
- Subjects :
- Alendronate pharmacology
Antibodies, Monoclonal adverse effects
Antibodies, Monoclonal, Humanized
Biomarkers metabolism
Demography
Denosumab
Female
Humans
Middle Aged
Organ Size drug effects
RANK Ligand adverse effects
Single-Blind Method
Time Factors
Treatment Outcome
Antibodies, Monoclonal pharmacology
Bone Density drug effects
Bone Density Conservation Agents pharmacology
Bone and Bones drug effects
Bone and Bones pathology
Postmenopause drug effects
RANK Ligand pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 8756-3282
- Volume :
- 43
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Bone
- Publication Type :
- Academic Journal
- Accession number :
- 18539106
- Full Text :
- https://doi.org/10.1016/j.bone.2008.04.007