E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Postmenopausal osteoporosis /osteopenia |
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MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of the study is to estimate the effect of denosumab (AMG 162), compared to placebo on cortical thickness at the distal radius, as determined by in-vivo microCT (XtremeCT®) at 12 months. |
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E.2.2 | Secondary objectives of the trial |
First four secondary objectives listed. Please see protocol (section 1.2) for remaining five secondary objectives.
• Estimate the effect of denosumab, compared to placebo, on cortical thickness at the distal radius, as determined by XtremeCT® at 6 months • Estimate the effect of denosumab, compared to placebo, on cortical thickness at the distal tibia, as determined by in-vivo microCT (XtremeCT®) at 6 and 12 months • Estimate the effect of denosumab, compared to placebo, on cortical and trabecular volumetric bone density at the distal radius and the distal tibia, as determined by in-vivo XtremeCT® at 6 and 12 months • Estimate the effect of denosumab, compared to alendronate (ALN), on cortical and trabecular volumetric bone density and on cortical thickness at the distal radius and the distal tibia, as determined by XtremeCT® at 6 and 12 months
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E.2.3 | Trial contains a sub-study | Information not present in EudraCT |
E.3 | Principal inclusion criteria |
Postmenopausal, ambulatory women between 50 and 70 years old. • Postmenopausal will be defined as no vaginal bleeding or spotting for at least 12 months. • If the 12 months can not be confirmed (i.e.: hysterectomy), and if in the opinion of the investigator there is uncertainty regarding menopausal status, confirmation of serum FSH (≥ 50 mIU/mL) or serum estradiol (≤ 20 pg/mL) must be obtained.
BMD values (g/cm2) at either the lumbar spine OR total hip as follows: • For lumbar spine, the BMD values (g/cm2) must be ≤ 0.940 (GE Lunar) or ≤ 0.827 (Hologic), OR • For total hip, the BMD values (g/cm2) must be ≤ 0.756 (GE Lunar) or ≤ 0.698 (Hologic) BMD values (g/cm2) at both the lumbar spine and total hip as follows: • For lumbar spine, BMD values (g/cm2) ≥ 0.820 (GE Lunar) or ≥ 0.717 (Hologic), AND • For total hip, BMD values (g/cm2) ≥ 0.630 (GE Lunar) or ≥ 0.576 (Hologic)
First and second lumbar vertebrae (L1 and L2) evaluable for DXA and QCT measurements Ethical - Before any study-specific procedure, the appropriate written informed consent must be obtained |
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E.4 | Principal exclusion criteria |
-Any disorder that compromises the ability of the subject to give written informed consent and/or to comply with study procedures. -History of a fragility fracture (a fracture resulting from no or minor trauma, i.e. a fall from standing height or less) of the wrist, humerus, hip or pelvis after age 50 -Presence of moderate or severe vertebral deformity on VFA or lateral spine radiograph if VFA is not obtainable or evaluable. -Vitamin D deficiency [25(OH) vitamin D level < 12 ng/mL]. -Evidence of any of the following per subject report, chart review or central laboratory result: a) Uncontrolled hyper- or hypothyroidism b) Current hyper- or hypoparathyroidism c) Elevated transaminases d) Impaired renal function as determined by serum creatinine ≥ 2.0 mg/dL e) Current hypo- or hypercalcemia determined by the central laboratory reference ranges for albumin adjusted serum calcium f) Active gastric or duodenal ulcer; history of significant gastrointestinal bleed requiring hospitalization or transfusion, or dyspepsia or gastroesophageal reflux disease that is uncontrolled by medication g) Rheumatoid arthritis, Paget’s disease, Cushing’s disease, hyperprolactinemia, or cirrhosis of the liver h) History of documented human immunodeficiency virus, hepatitis C virus, or hepatitis B i) Malignancy (except excised cutaneous basal cell, excised squamous cell carcinoma or excised cervical or breast ductal carcinoma in situ) within the last 5 years j) Any metabolic bone disease, e.g., osteomalacia or osteogenesis imperfecta, which may interfere with the interpretation of study results k) Malabsorption syndrome or any gastrointestinal disorders associated with malabsorption -Received any solid organ or bone marrow transplant. -Contraindicated or poorly tolerant of ALN therapy. -Known sensitivity to mammalian cell derived drug products. -Known intolerance to elemental calcium supplements. -Any history of intravenous bisphosphonate, fluoride (except for dental treatment) or strontium ranelate use. -Oral bisphosphonate treatment. a) ≥ 3 months cumulatively, OR b) ≥ 1 month cumulatively in the past year, OR c) Any use during the 3-month period prior to randomization -Treatment with PTH or PTH derivatives within the last year -Administration of any of the following treatments within 3 months of randomization: a) Any SERM (e.g., raloxifene) b) Tibolone c) Anabolic steroids or testosterone d) Glucocorticosteroids (≥ 5 mg prednisone equivalent per day for more than 10 days) e) Systemic (oral, transdermal, topical) hormone replacement therapy (local vaginal estrogen preparation will be allowed) f) Calcitonin g) Calcitriol or vitamin D derivatives h) Other bone active drugs including anti-convulsives (except benzodiazepines) and heparin i) Chronic systemic ketoconazole, androgens, ACTH, cinacalcet, aluminum, lithium, protease inhibitors, methotrexate, gonadotropin-releasing hormone agonists -Height, weight or girth which may preclude accurate DXA or QCT measurements. -Neither wrist evaluable by XtremeCT® (i.e., bilateral wrist replacement). -Neither hip evaluable by DXA and QCT (i.e., bilateral hip replacement or pins in both hips). -Presence of significant extremity tremor which, in the opinion of the investigator, would interfere with the XtremeCT® measurement. -Currently enrolled in or has not yet completed at least 1 month since ending other investigational device or drug trial(s), or subject is receiving other investigational agent(s). -Any laboratory abnormality or physical or psychiatric disorder which, in the opinion of the investigator, will prevent the subject from completing the study or interfere with the interpretation of the study results. -Evidence of alcohol or substance-abuse within the last 12 months which the investigator believes would interfere with understanding or completing the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is percent change in cortical thickness at the distal radius as determined by XtremeCT® from baseline to 12 months. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Information not present in EudraCT |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Information not present in EudraCT |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 10 |