E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Postmenopausal Osteoporosis |
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E.1.1.1 | Medical condition in easily understood language |
Postmenopausal Osteoporosis |
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E.1.1.2 | Therapeutic area | Body processes [G] - Bones and nerves physological processes [G11] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10031285 |
E.1.2 | Term | Osteoporosis postmenopausal |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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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 |
For the 12-month double-blind placebo-controlled study period:
To assess the effect of romosozumab treatment for 12 months compared with placebo on the subject incidence of new vertebral fracture
For the 24-month study period:
To assess the effect of romosozumab treatment for 12 months followed by denosumab treatment for 12 months compared to placebo followed by denosumab treatment on the subject incidence of new vertebral fracture. |
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E.2.2 | Secondary objectives of the trial |
For the 12-month double-blind placebo-controlled study period -
• Subject incidence of fractures (clinical fracture, nonvertebral fracture, new or worsening vertebral fracture, major nonvertebral fracture, hip fracture, major osteoporotic fracture, and multiple new or worsening vertebral fracture)
• Percent changes in bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck
For the overall 24-month study period (12-month double-blind placebo-controlled study period followed by the 12-month open-label denosumab follow-up study period) -
• Subject incidence of fractures (new vertebral fracture, clinical fracture, nonvertebral fracture, new or worsening vertebral fracture, major nonvertebral fracture, hip fracture, major
osteoporotic fracture, and multiple new or worsening vertebral fracture)
• Percent changes in BMD at the lumbar spine, total hip, and femoral neck |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
- Pharmacokinetics (PK) Sub-study
- Bone Turnover Marker (BTM) & Biomarker Sub-study
- Forearm and Total Body Dual-energy X-ray Absorptiometry (DXA) and High Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) Sub-study
- Lumbar Spine and Proximal Femur DXA Sub-study
- Bone Biopsy Sub-study
- Calcium Sub-study
- Audiology Sub-study
- Osteoarthritis Sub-study
- Pharmacogenetics Sub-study
- Serum iPTH and Urinary Calcium Sub-study |
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E.3 | Principal inclusion criteria |
- Ambulatory postmenopausal women, age ≥ 55 to ≤ 90 years at
randomization. Postmenopause is defined as no vaginal bleeding or
spotting for 12 consecutive months prior to screening.
- BMD T-score ≤ -2.50 at the total hip or femoral neck, as assessed by the central imaging vendor at the time of screening, based on DXA scans and using data for Caucasian women from the National Health and Nutritional Examination Survey (NHANES) 1998.
- At least 2 vertebrae in the L1-L4 region and at least one hip are evaluable by DXA, as assessed by the principal investigator, eg, based on lateral spine x-rays
- Subject has provided informed consent |
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E.4 | Principal exclusion criteria |
- BMD T-score ≤ -3.50 at the total hip or femoral neck
- History of hip fracture
- Any severe (SQ3) or more than 2 moderate (SQ2) vertebral fractures
Use of the following agents affecting bone metabolism:
- Strontium ranelate or fluoride (for osteoporosis): more than one month of cumulative use within 5 years prior to randomization
- IV bisphosphonates:
• Zoledronic acid:
- any dose received within 3 years prior to randomization
- more than 1 dose received within 5 years prior to randomization
• IV ibandronate or IV pamidronate:
- any dose received within 12 months prior to randomization
- more than 3 years of cumulative use, unless last dose received ≥ 5 years prior to randomization
- Oral bisphosphonates
• More than 3 years of cumulative use, unless last dose received ≥ 5 years prior to randomization
• Any dose received within 3 months prior to randomization
• More than 1 month of cumulative use between 3 and 12 months prior to randomization
- Denosumab or any cathepsin K inhibitor, such as odanacatib (MK-0822): any dose received within 18 months prior to randomization
- Teriparatide or any PTH analogs:
• any dose received within 3 months prior to randomization
• more than 1 month of cumulative use between 3 and 12 months prior to randomization
- Systemic oral or transdermal estrogen or SERMs, or calcitonin: more than 1 month of cumulative use within 6 months prior to randomization
- Hormonal ablation therapy: more than 1 month of cumulative use within 6 months prior to randomization
- Tibolone, cinacalcet or calcitonin: any dose received within 3 months prior to randomization
- Systemic glucocorticosteroids: ≥ 5 mg prednisone equivalent per day for more than 14 days within 3 months prior to randomization
- History of metabolic or bone disease that may interfere with the interpretation of the results
- History of solid organ or bone marrow transplants
- History of osteonecrosis of the jaw
- Vitamin D insufficiency, defined as 25 (OH) vitamin D levels < 20 ng/mL
- Current hyper- or hypocalcemia, defined as albumin-adjusted serum calcium outside the normal range, as assessed by the central laboratory.laboratory. Serum calcium levels may be retested once in case of an elevated serum calcium level within 1.1x the upper limit of normal (ULN) as assessed by the central laboratory.
- Current, uncontrolled hyper- or hypothyroidism
- Current, uncontrolled hyper- or hypoparathyroidism
- Possible diagnosis of multiple myeloma or related lymphoproliferative disorder
- Contraindicated or intolerant to denosumab therapy
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E.5 End points |
E.5.1 | Primary end point(s) |
During the 12-month double-blind placebo-controlled study period:
• Subject incidence of new vertebral fracture through Month 12
During the overall 24-month study period (12-month double-blind placebo-controlled study period followed by the 12-month open-label denosumab follow-up study period):
• Subject incidence of new vertebral fracture through Month 24 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
During the 12-month double-blind placebo-controlled study period:
• Subject incidence of clinical fracture (nonvertebral fracture and clinical vertebral fracture) through Month 12
• Subject incidence of nonvertebral fracture through Month 12
• Subject incidence of new or worsening vertebral fracture through Month 12
• Subject incidence of major nonvertebral fracture (pelvis, distal femur, proximal tibia, ribs, proximal humerus, forearm, and hip) through Month 12
• Subject incidence of hip fracture through Month 12
• Subject incidence of major osteoporotic fracture (hip, wrist, humerus, and clinical vertebral) through Month 12
• Subject incidence of multiple new or worsening vertebral fracture through Month 12
• Percent change from baseline in BMD at the lumbar spine, total hip, and femoral neck at Month 12
During the overall 24-month study period (12-month double-blind placebo-controlled study period followed by the 12-month open-label denosumab follow-up study period):
• Subject incidence of clinical fracture (nonvertebral fracture and clinical vertebral fracture) through Month 24
• Subject incidence of nonvertebral fracture through Month 24
• Subject incidence of new or worsening vertebral fracture through Month 24
• Subject incidence of major nonvertebral fracture (pelvis, distal femur, proximal tibia, ribs, proximal humerus, forearm, and hip) through Month 24
• Subject incidence of hip fracture through Month 24
• Subject incidence of major osteoporotic fracture (hip, wrist, humerus, and clinical vertebral) through Month 24
• Subject incidence of multiple new or worsening vertebral fracture through Month 24
• Percent change from baseline in BMD at the lumbar spine, total hip, and femoral neck at Month 24
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | No |
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 | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
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) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 87 |
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 | No |
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 |
Argentina |
Australia |
Belgium |
Brazil |
Canada |
Colombia |
Czech Republic |
Denmark |
Dominican Republic |
Estonia |
Germany |
Hong Kong |
Hungary |
India |
Japan |
Latvia |
Lithuania |
Mexico |
New Zealand |
Poland |
Romania |
Spain |
Switzerland |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 | 3 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 2 |