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A Six-month Phase 2 Study of Oral hPTH(1-34) (EBP05) in Postmenopausal Women With Low Bone Mass

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04003467
Recruitment Status : Recruiting
First Posted : July 1, 2019
Last Update Posted : October 6, 2020
Sponsor:
Information provided by (Responsible Party):
Entera Bio Ltd.

Brief Summary:
This is a double-blinded randomized study to determine the effects of treatment on biochemical markers of bone formation and bone resorption, and bone mineral density (BMD) for 6 months of treatment with EBP05 or placebo. Approximately 160 postmenopausal women with low bone mass (BMD T-score lower than or equal to -2.0 in at least one location: Lumbar Spine, Femoral Neck or Total Hip sites) over 50 years of age will receive Study Medication. Protocol Version 3.0 described the study design for the initial 103 subjects randomized. The current Version 4.0 describes the study design for approximately 60 additional randomized subjects. After completion of all screening procedures eligible subjects will come for the first visit and will be randomized to one of three treatment arms (EBP05 1.5 mg, 2.5 mg or placebo). A randomized allocation schedule will allocate 6 to EBP05 1.5 mg, 36 to 2.5 mg and 18 to placebo.

Condition or disease Intervention/treatment Phase
Osteoporosis Drug: EBP05 Drug: Placebo of EBP05 Phase 2

Detailed Description:

The screening phase to evaluate subject eligibility may start 56 days prior to the treatment phase. BMD screening (DXA scan) will be performed locally on approved vendors standardized machines and interpreted locally. If a subject is found to be suitable, the BMD results will be sent for central reading. The screening DXA scan should be sent to the central reading vendor at least 10 days prior to scheduled potential Day 1 in order to allow timely turnaround of results. The site will receive unblinded results.

A DXA BMD scan performed for medical care unrelated to the study may be used as the screening BMD if obtained no more than 14 days prior the start of screening and performed with the same scanner which was qualified for the study. If the subject is eligible for randomization, the DXA scan does not have to be repeated unless there is a delay in the start of Study Medication beyond the 28-day Screening period.

Protocol Version 3.0 describes the randomization of the first 103 subjects. In Protocol version 4.0, after completion of all screening procedures eligible subjects will come for the first visit and will be randomized to one of three treatment arms (EBP05 1.5 mg, 2.5 mg or placebo). A randomized allocation schedule will allocate 6 to EBP05 1.5 mg, 36 to 2.5 mg and 18 to placebo.

In Protocol Version 5.0 the starting dose of EBP05 for subjects randomized into the EBP05 2.5 mg treatment group was changed to 1.5 mg (3 tablets). Subjects randomized to Placebo and assigned to the 5 placebo tablet group will also be started on 3 tablets. At the Month 1 visit, the starting dose will be increased to 4 tablets of EPB05 (2.0 mg) or placebo if no continuing drug-related AEs (as assessed by the Investigator) are present. At Month 2 the dose will be increased to 5 tablets of EPB05 (2.5 mg) or placebo if no continuing drug-related AEs are present. If symptoms associated with administration of Study Medication occur with a dose increase, the dose should be decreased to 3 tablets daily (1.5 mg). Subjects who tolerate the highest dose (5 tablets, 2.5 mg) without drug-related symptoms will continue on that dose for the remainder of the study. Subjects who do not tolerate a dose increase (either 3 tablets to 4 tablets or 4 tablets to 5 tablets) will have their dose reduced to 3 tablets (1.5 mg) daily.

Subjects will receive Study Medication and education on Study Medication intake.

Subjects will visit the clinic once a month for the first three months, and at 6 months for the end of treatment or at any time in-between for an Early Termination Visit, if applicable. There will be telephone calls at Week 2, Month 4 and Month 5 for a general compliance/safety check. The final follow-up visit will also be conducted by phone.

The 6-month DXA scan will be sent for central reading. Unblinded results will not be released to the sites prior to Data Base Lock.

At the End of Treatment visit, concomitant medications will be reviewed, and outcome of AEs recorded, if applicable. The subjects must return all used Study Medication containers. Unused medication should also be returned, collected and accounted for.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 160 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Six-month Phase 2 Study of Oral hPTH(1-34) (EBP05) in Postmenopausal Women With Low Bone Mass
Actual Study Start Date : June 30, 2019
Estimated Primary Completion Date : April 2021
Estimated Study Completion Date : October 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: EBP05 1.5mg
6 subjects will be randomly assigned to receive 3 tablets of EBP05 containing 0.5mg hPTH(1-34) orally each day for 6 months
Drug: EBP05
tablets
Other Names:
  • hPTH(1-34)
  • Teriparatide

Experimental: Placebo for EBP05 0.5mg (3 or 5)
18 subjects will be randomly assigned to receive 3 or 5 tablets of matching EBP05 placebo orally each day for 6 months
Drug: Placebo of EBP05
tablets
Other Name: Placebo

Experimental: EBP05 2.5mg
36 subjects will be randomly assigned to receive 5 tablets of EBP05 containing 0.5mg hPTH(1-34) orally each day for 6 months
Drug: EBP05
tablets
Other Names:
  • hPTH(1-34)
  • Teriparatide




Primary Outcome Measures :
  1. Mean % change in P1NP from baseline after 3 months of treatment [ Time Frame: baseline, 3 months ]
    Determine the change in P1NP from baseline during treatment with oral EBP05 for 3 months compared with the change during treatment with placebo


Secondary Outcome Measures :
  1. Mean % change in BMD (lumbar) from baseline after 6 months of treatment [ Time Frame: baseline, 6 months ]
    Determine the change in BMD (lumbar spine) from Baseline at Month 6 compared with the change during treatment with placebo

  2. Mean % change in BMD (Femoral Neck and Total Hip) from baseline after 6 months of treatment [ Time Frame: baseline, 6 months ]
    Determine the change in BMD (Femoral Neck and Total Hip) from Baseline at Month 6 compared with the change during treatment with placebo.

  3. Mean % change in P1NP from baseline after 6 months of treatment [ Time Frame: baseline, 6 months ]
    Determine the change in P1NP from baseline during treatment with oral EBP05 for 6 months compared with the change during treatment with placebo.

  4. Mean % change in osteocalcin and bone alkaline phosphatase from baseline after 6 months of treatment [ Time Frame: baseline, 6 months ]
    Determine the changes in osteocalcin and bone alkaline phosphatase from baseline during treatment with oral EBP05 for 3 and 6 months compared with the change during treatment with placebo.

  5. Mean % change in serum CTX and urine NTX/Creatinine from baseline after 3 months of treatment [ Time Frame: baseline, 3 months ]
    Determine the change in serum CTX and urine NTX/Creatinine from baseline during treatment with oral EBP05 for 3 months compared with the change during treatment with placebo.

  6. Mean % change in serum CTX and urine NTX/Creatinine from baseline after 6 months of treatment Change of BMD (lumbar) after 6 months of treatment [ Time Frame: baseline, 6 months ]
    Determine the changes in serum CTX and urine NTX/Creatinine from baseline during treatment with oral EBP05 for 6 months compared with the change during treatment with placebo.

  7. Concentration of plasma hPTH(1-34) 15 min after Study Medication administration [ Time Frame: 6 months ]
    Provide descriptive statistics of plasma hPTH(1-34) concentration 15 min. after Study Medication administration at Day 1, Month 1, Month 3 and Month 6 by treatment group


Other Outcome Measures:
  1. Mean % change in urine cyclic AMP/ creatinine by treatment groups [ Time Frame: 6 months ]
    Determine the effect of treatment with EBP05 and placebo on urine cyclic AMP/ creatinine (total urine collected over 1.5-hour post dose) on Day 1, Month 1, Month 3 and Month 6 as a pharmacodynamic response to EPB05

  2. Correlation between mean urine cyclic AMP/ creatinine at Month 3 and Month 6 and mean % change in P1NP from baseline at Months 3 and 6 [ Time Frame: 6 months ]
    Evaluate the correlation between urine cyclic AMP/ creatinine (total urine collected over 1.5-hour post dose) at Month 3 and Month 6 and P1NP change from baseline at Months 3 and 6

  3. Correlation between plasma hPTH(1-34) and urine cyclic AMP/ creatinine at different timepoints [ Time Frame: 6 months ]
    Evaluate the correlation between plasma hPTH(1-34) 15 minutes after oral administration of EBP05 and urine cyclic AMP/ creatinine (total urine collected over 1.5-hour post dose).



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   50 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Gender Based Eligibility:   Yes
Gender Eligibility Description:   postmenopausal women with low bone mass
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

  1. Female subjects above 50 years of age
  2. Signed Informed Consent Form
  3. Able to adhere to the visit schedule and protocol requirements
  4. At least 3 years post menopause (physiological or surgical)
  5. Women who are less than 55 years old need to have estradiol and LH in the menopausal range
  6. Low bone mass (BMD T-score lower than or equal to -2.0 in at least one location: Lumbar Spine, Femoral Neck or Total Hip sites)

    Exclusion criteria:

  7. Active gastrointestinal inflammatory disorder, gastrointestinal motility disorders, and chronic gastritis, such as ulcerative colitis, Crohn's disease, irritable bowel syndrome, short bowel syndrome, celiac disease, gastroparesis, etc. that may affect drug bioavailability
  8. Any conditions or factors that, in the judgment of the Investigator, somehow may impact gastrointestinal absorption, distribution or metabolism of parathyroid hormone analogues, or known to potentiate or predispose to undesired effects
  9. History of significant gastrointestinal, liver or kidney disease, or surgery (including bariatric surgery) that may affect drug bioavailability
  10. Acute illness within 14 days of screening
  11. History of clinically significant cardiovascular, renal, hepatic, chronic respiratory or gastrointestinal disease, neurological or psychiatric disorder, that may result in either increased risk or limit her ability to comply with Study Medication administration and scheduled clinical evaluations, as judged by the investigator
  12. Blood donation (greater than or equal to 500 mL) within 30 days prior to screening
  13. History of Paget's disease of bone
  14. History of prior external beam or implant radiation therapy involving the skeleton
  15. Active urolithiasis
  16. Primary hyperparathyroidism
  17. History of alcohol or substance abuse within 3 years prior to screening
  18. The subject has used an investigational drug within 30 days before the screening visit
  19. Any past treatment with Forteo®
  20. History of oncologic disease except for past medical history of a) basal cell or squamous cell skin cancer resected for cure or b) papillary or follicular thyroid cancer localized to the thyroid and resected for cure with no evidence of local or distant recurrence ≥ 5 years after surgery.
  21. Allergy to soy or known hypersensitivity to PTH
  22. Known allergies or sensitivities to components of the Study Medication
  23. Abnormal calcium, magnesium, phosphate or alkaline phosphatase (outside of lab reference ranges and clinically significant) on screening visit
  24. Significant renal impairment (eGFR <45mL/min/1.73 m2 as measured by MDRD)
  25. Any other clinically significant abnormal biochemistry, hematology or urinalysis at screening that are not explained by a disease recorded in the subject's medical history, as judged by the investigator
  26. Chronic morning medication that cannot be taken at least 1-hr post-Study Medication dose
  27. Any osteoporosis treatment within the last 2 years. Hormone therapy with oral, transdermal or injectable estradiol, estrogen analog or SERM (e.g. raloxifene) is considered an osteoporosis treatment. Topical estrogen for menopausal vaginal symptoms is permitted.
  28. Any use of fluoride (dose greater than 1 mg/day) or strontium ranelate
  29. Any use of intravenous bisphosphonate in the last 10 years.
  30. Any use of denosumab within the last 3 years
  31. Any oral bisphosphonate use for more than 6 months (or Risedronate for over 1 year) in the last 5 years.
  32. Any oral bisphosphonate except risedronate for more than 3 years ending in the last 5 years; or risedronate for more than 5 years ending in the last 5 years.
  33. Systemic glucocorticoids (current use: ≥ 2.5 mg prednisone or equivalent), or prior use ≥ 5 mg per day for more than 1 week in the last year
  34. Hyperthyroidism or hypothyroidism not treated with thyroxine replacement to achieve normal TSH
  35. Serious medical conditions currently under evaluation or treatment
  36. Disorders of bone and mineral metabolism other than osteoporosis, including a known history of Vitamin D deficiency with metabolic significance that has not been treated with Vitamin D for at least 6 months.
  37. Severe osteoporosis defined as a BMD below -3.5 or previous osteoporotic (low-energy trauma) fracture(s) that in the investigator's opinion preclude the use of placebo.
  38. The Investigator should exclude subjects at his own judgement, who are at very high risk of osteoporotic fracture(s) and require immediate treatment.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04003467


Locations
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Israel
Hadassah Medical Center, Mt. Scopus Hospital Recruiting
Jerusalem, Israel, 9765422
Contact: Auryan Szalat, MD    02-5845384    auryans@hadassah.org.il   
Principal Investigator: Auryan Szalat, MD         
Rabin Medical Center, Beilinson Campus Recruiting
Petach Tikva, Israel, 4941492
Contact: Gloria Tsvetov, MD    03-9376997    gloriats@clalit.org.il   
Principal Investigator: Gloria Tsvetov, MD         
Sheba Medical Center Recruiting
Ramat-Gan, Israel, 5262160
Contact: Liana Tripto-Shkolnik, MD    03-5305475    Triptoshkolnik.liana@sheba.health.gov.il   
Principal Investigator: Liana Tripto-Shkolnik, MD         
Tel-Aviv Sourasky Medical Center Recruiting
Tel Aviv, Israel, 6423906
Contact: Vanessa Rouach, MD    03-6974243    v.rouach@gmail.com   
Principal Investigator: Vanessa Rouach, MD         
Sponsors and Collaborators
Entera Bio Ltd.
Investigators
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Study Director: Arthur Santora, MD Entera Bio Ltd.
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Responsible Party: Entera Bio Ltd.
ClinicalTrials.gov Identifier: NCT04003467    
Other Study ID Numbers: ENT-07-2019
First Posted: July 1, 2019    Key Record Dates
Last Update Posted: October 6, 2020
Last Verified: October 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Entera Bio Ltd.:
Osteoporosis
hPTH(1-34)
Additional relevant MeSH terms:
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Osteoporosis
Bone Diseases, Metabolic
Bone Diseases
Musculoskeletal Diseases
Metabolic Diseases
Teriparatide
Calcium-Regulating Hormones and Agents
Physiological Effects of Drugs
Bone Density Conservation Agents