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

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Miller, Paul D.¹; Bolognese, Michael A.²; Lewiecki, E. Michael³; McClung, Michael R.⁴; Ding, Beiying⁵; Austin, Matthew⁵; Liu, Yu⁵; San Martin, Javier⁵

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

Bone. August 2008;43(2):222-229

©2008 Elsevier Inc. All rights reserved.

Affiliations

¹Colorado Center for Bone Research, 3190 South Wadsworth Blvd, Ste 250, Lakewood, CO 80227, USA

²Bethesda Health Research Center, Bethesda, MD, USA

³New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA

⁴Oregon Osteoporosis Center, Portland, OR, USA

⁵Amgen Inc., Thousand Oaks, CA, USA
Abstract and keywords

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.

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.

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.

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.

Keywords: Bone mineral density; Denosumab; Fully human monoclonal antibody; Osteoporosis; RANKL
Links

DOI: 10.1016/j.bone.2008.04.007

PubMed: 18539106

WoS: 000257928300001
History

Received: 2008-01-15

Revised: 2008-04-1

Accepted: 2008-04-8

Online: 2008-04-26

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