Combined Administration of Teripapartide and Antiresorptive Agents in Postmenopausal Osteoporosis (Confors)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Dr. Christian Muschitz, Medical University of Vienna
ClinicalTrials.gov Identifier:
NCT01535027
First received: December 20, 2011
Last updated: December 30, 2012
Last verified: December 2012
  Purpose

Increased bone formation in the absence of accelerated resorption is resulting in a marked anabolic response to teriparatide (TPTD) during the early phase after treatment initiation. Months later, due to coupling mechanism, the sustained increase of bone formation and ongoing anabolic effects are accompanied by significantly increased bone resorption as well. Antiresorptives influence the balance of bone formation and resorption. Therefore the investigators aim is to investigate the effects of the addition of antiresorptives to the second half of TPTD cycle when resorption is already also markedly elevated.


Condition Intervention Phase
Osteoporosis
Drug: teriparatide
Drug: teriparatide and raloxifene
Drug: teriparatide and alendronate
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase IV Study Teriparatide and Antiresorptive Combination Treatment Subsequent to 9 Months of Teriparatide Monotherapy

Resource links provided by NLM:


Further study details as provided by Medical University of Vienna:

Primary Outcome Measures:
  • Differences in changes of areal lumbar spine BMD between the three treatment groups [ Time Frame: Evaluation after 9, 12 and 18 months of TPTD ] [ Designated as safety issue: No ]
    Primary objective To investigate the changes in lumbar spine BMD of patients among the three treatment groups


Secondary Outcome Measures:
  • Differences in changes of BMDs and markers of bone turnover among the three treatment groups after 18 months TPTD treatment [ Time Frame: Evaluation after 9, 12 and 18 months of TPTD treatment ] [ Designated as safety issue: Yes ]

    Secondary objectives

    • Differences in change of biochemical markers of bone turnover (serum CTX and serum PINP) between treatment groups
    • Differences in change of the additional DXA results in the hip scan (neck, upper neck, nape, Wards, Troch, shaft, total hip [g/cm²]) of patients between treatment groups
    • To investigate the volumetric changes of vertebral and hip BMD by quantitative computertomography of patients between treatment groups
    • To investigate safety and tolerability of the treatments


Enrollment: 125
Study Start Date: March 2006
Study Completion Date: December 2012
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Teriparatide
18 months of daily 20 ug sc. teriparatide monotherapy (TPTD)
Drug: teriparatide
teriparatide 20 ug/day, sc.
Other Name: Forteo
Active Comparator: Teriparatide and Raloxifene
9 months teriparatide 20 ug/day sc. monotherapy (TPTD) continued by combination therapy of raloxifene 60 mg/day orally(RAL)and TPTD for another 9 months
Drug: teriparatide and raloxifene
teriparatide 20 ug/day sc. raloxifene 60mg oral daily
Other Names:
  • Forteo
  • Evista
Active Comparator: Teriparatide and Alendronate
9 months teriparatide monotherapy 20 ug/day sc.(TPTD) continued by combination therapy of alendronate 70 mg/week orally(ALN)and TPTD for another 9 months
Drug: teriparatide and alendronate
teriparatide 20 ug/day sc. alendronate 70mg oral weekly
Other Names:
  • Forteo
  • Fosamax

Detailed Description:

We prospectively randomize 125 postmenopausal women after 9 months of TPTD treatment into three different open-label groups for another 9 months: either alendronate (ALN, 70 mg/week), raloxifene (RAL, 60 mg/day) or no medication (TPTD mono) on top of ongoing TPTD treatment.

All subjects receive daily supplementation of 1000mg calcium and 800 IU vitamin D.

Serum level of intact amino terminal propeptide of type I procollagen (PINP) and type 1 collagen cross-linked C-telopeptide (CTX) as well as DXA measurement at the spine, total hip and femoral neck BMD are evaluated at TPTD treatment initiation, at baseline of randomization to antiresorptive therapy as well as at 3 and 9 months during the combination treatment.Volumetric BMD values will be also determined.

  Eligibility

Ages Eligible for Study:   55 Years to 88 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Ambulatory postmenopausal women at least 55 years of age
  • Patients with "unsatisfactory clinical response to previous antiresorptive therapy" according to the national reimbursement criteria of Austria (either new clinical or radiographic fragility fracture on ≥ 2 years and/or accelerated bone loss of ≥ 3.5%/year on antiresorptive treatment; discontinuation of oral antiresorptive treatment due to side-effects and substantial risk for osteoporotic fracture defined by a T-Score ≤ -2.5 or ≥ 2 clinical risk factors according to the FRAX™-algorithm)and consequently started with teriparatide treatment
  • Patients treated with teriparatide (20 ug/day) currently and since 9 months for postmenopausal osteoporosis
  • Lumbar spine, femoral neck, and total hip evaluable by dual energy x ray absorptiometry (DXA)
  • Normal or clinically non-significant abnormal laboratory values (as defined by the investigator)
  • Without language barrier, cooperative, expected to return for all follow-up procedures, and who give informed consent before entering the study and after being informed of the medications and procedures to be used in this study

Exclusion Criteria:

  • History of bone metabolic diseases, Paget's disease, renal osteodystrophy, osteomalacia, any secondary causes of osteoporosis, hyperparathyroidism (uncorrected), and intestinal malabsorption
  • History of malignant neoplasms in the prior 5 years, with the exception of superficial basal cell carcinoma or squamous cell carcinoma of the skin that has been definitively treated. If malignant neoplasm was ever diagnosed, patient must presently be free of disease
  • History of nephrolithiasis or urolithiasis in the prior 2 years. Patients with any documented history of nephro- or uro-lithiasis must have had an appropriate imaging procedure within the prior 6 months, such as, an intravenous pyleogram (IVP), supine radiograph of the kidney ureter bladder, or renal ultrasound, which must document the absence of stones
  • Abnormal thyroid function at any time in the prior 6 months. Patients with chronic hypothyreosis and adequate substitution therapy are permitted
  • Active liver disease (liver enzymes more than three times the upper limit of normal) or clinical jaundice
  • Significantly impaired renal function. This is defined as serum creatinine >1.8 mg/dL
  • Treatment with bone active agent other than teriparatide in the prior 9 months
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01535027

Locations
Austria
Medical University of Vienna
Vienna, Austria, 1060
Sponsors and Collaborators
Medical University of Vienna
Investigators
Principal Investigator: Christian Muschitz, M.D. Medical University of Vienna
  More Information

Additional Information:
No publications provided by Medical University of Vienna

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Dr. Christian Muschitz, Principle Investigator, Medical University of Vienna
ClinicalTrials.gov Identifier: NCT01535027     History of Changes
Other Study ID Numbers: Vinforce-003
Study First Received: December 20, 2011
Last Updated: December 30, 2012
Health Authority: Austria: Ethikkommission

Keywords provided by Medical University of Vienna:
teriparatide
alendronate
raloxifene
bone mineral density

Additional relevant MeSH terms:
Osteoporosis
Osteoporosis, Postmenopausal
Bone Diseases, Metabolic
Bone Diseases
Musculoskeletal Diseases
Alendronate
Teriparatide
Raloxifene
Bone Density Conservation Agents
Physiological Effects of Drugs
Pharmacologic Actions
Estrogen Antagonists
Estrogen Receptor Modulators
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Selective Estrogen Receptor Modulators

ClinicalTrials.gov processed this record on September 18, 2014