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Denosumab for the Treatment of Osteoporosis in Children: A Pilot Study

Primary Purpose

Osteoporosis

Status

Completed

Phase

Phase 2

Locations

Canada

Study Type

Interventional

Intervention

Zoledronic Acid

Denosumab

About this trial

This is an interventional treatment trial for Osteoporosis

Eligibility Criteria

4 Years - 16 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Subject or subject's legally acceptable representative has provided informed consent.
Children aged 4 to 16 years at the time of enrolment.
Children with a history of clinically significant bone fragility in the preceding 24 months, requiring the child to have ONE or more of the following clinical profiles:
1. At least one low-trauma vertebral or long bone fracture in a child with an underlying disease known to be associated with osteoporotic fractures (e.g. glucocorticoid-treated diseases, Crohn's disease, rheumatic disorders, Duchenne muscular dystrophy, other muscular dystrophies, spinal muscular atrophy, cerebral palsy); OR
2. At least one low-trauma vertebral or long bone fracture in the last 24 months, in a child with a known genetic osteoporotic condition such as osteogenesis imperfecta (confirmed on molecular genetic testing); OR
3. At least one low-trauma vertebral or long bone fracture in the last 24 months, in an otherwise healthy child with a diagnosis of osteoporosis confirmed on trans-iliac bone biopsy. Trans-iliac bone biopsy is a requirement in this sub-group as per the usual standard of care, as this is the only test that will definitively confirm osteoporosis in an otherwise healthy child who does not have a genetic bone fragility condition.

Exclusion Criteria:

Any child for whom the treating physician feels participation is not advised.
Prior treatment with an osteoporosis agent (e.g. bisphosphonate).
Renal insufficiency defined as an eGFR less than 60ml/min/1.73m2.
Active or prior diagnosis of malignancy or undergoing investigations for a suspected childhood cancer.
Currently breastfeeding or plans to breastfeed during the study.
Pregnancy (verified by pre-treatment pregnancy test in all menstruating or sexually active females).
Untreated vitamin D deficiency, defined as a serum 25OHD level <50nmol/L.
Untreated hypocalcemia, defined as a serum ionized calcium level <1.1mmol/L.
Active or historic eczema/cellulitis.
Children planning dental procedures and/or dental surgery during the course of the study.
Children with a documented history of atrial fibrillation.
Children with asthma who are acetylsalicylic acid (ASA) sensitive.
Children that have had parathyroid or thyroid surgery.
Children who are allergic to rubber or latex.
Males with a pregnant partner.

Sites / Locations

Children's Hospital of Eastern Ontario

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Zoledronic Acid

Denosumab

Arm Description

Intravenous zoledronic acid 0.025mg/kg

Subcutaneous denosumab 1.0mg/kg

Outcomes

Primary Outcome Measures

The changes in serum ionized calcium levels at 48 hours following the administration of denosumab versus zoledronic acid.

To observe the changes in serum ionized calcium levels at 48 hours following the administration of denosumab versus zoledronic acid. Hypocalcemia at 48 hours has been chosen as the primary outcome since this is a clinically important side effect of both denosumab and zoledronic acid, and 48 hours is around the time of the anticipated calcium nadir

Secondary Outcome Measures

Full Information

NCT ID

NCT02632916

First Posted

December 15, 2015

Last Updated

June 22, 2020

Sponsor

Children's Hospital of Eastern Ontario

1. Study Identification

Unique Protocol Identification Number

NCT02632916

Brief Title

Denosumab for the Treatment of Osteoporosis in Children: A Pilot Study

Official Title

A Single-Blinded, Randomized, Controlled, Phase 2 Pilot Study to Evaluate the Safety and Efficacy of Denosumab Compared to Zoledronic Acid for the Treatment of Osteoporosis in Children

Study Type

Interventional

2. Study Status

Record Verification Date

June 2020

Overall Recruitment Status

Completed

Study Start Date

August 2016 (undefined)

Primary Completion Date

February 3, 2020 (Actual)

Study Completion Date

February 3, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

Children's Hospital of Eastern Ontario

4. Oversight

Studies a U.S. FDA-regulated Device Product

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

The aim of this study is to acquire preliminary, pilot data over a 2-year period on the safety and efficacy of subcutaneous denosumab versus the current CHEO standard-of-care (intravenous zoledronic acid) for the treatment of osteoporosis in children. Both denosumab (1.0mg/kg) and zoledronic acid (0.025mg/kg) will be given as four doses separated by a six month interval (i.e. at baseline, 6 months, 12 months and 18 months), with follow-up to 2 years.

Detailed Description

Bone fractures without significant trauma (also known as osteoporosis) are a frequent complication of chronic childhood diseases (for example, Duchenne muscular dystrophy and inflammatory disorders) and genetic disorders (such as osteogenesis imperfecta). To date, the only effective therapy for the treatment of osteoporosis in children is a class of medications known as bisphosphonates (which include pamidronate and zoledronic acid). Unfortunately, these medications have the disadvantage of frequent side effects with the first dose (including fever, nausea, vomiting and bone pain), as well as intravenous administration (delivery through a vein, similar to a bloodtest). Recently, a new medication has been proven effective in the treatment of adults with osteoporosis - this medication is called denosumab, and it has a distinct advantage over intravenous bisphosphonates since it is administered sub-cutaneously (through a small needle injected into the skin), plus an excellent safety profile. To date, denosumab has been used with success in a few children with rare forms of osteoporosis and other bone disorders. The purpose of this study is to further test the safety and benefits of denosumab in children with fractures due to osteoporosis, by comparing this new agent to the current standard treatment at CHEO, zoledronic acid. This will be a one year, pilot study in 20 children with a variety of forms of osteoporosis. Children enrolled in the study will be randomly assigned to receive zoledronic acid or denosumab every 6 months (for two doses), with tests carried out every few months over the course of the year to study the effects of these therapies on fractures, bone density and various safety parameters as measured by bloodtests. Overall, the results of this study will provide us with important information on the potential for denosumab to provide children with a safe, effective and convenient new osteoporosis treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Osteoporosis

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

Outcomes Assessor

Allocation

Randomized

Enrollment

10 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Zoledronic Acid

Arm Type

Active Comparator

Arm Description

Intravenous zoledronic acid 0.025mg/kg

Arm Title

Denosumab

Arm Type

Experimental

Arm Description

Subcutaneous denosumab 1.0mg/kg

Intervention Type

Drug

Intervention Name(s)

Zoledronic Acid

Intervention Description

Intravenous zoledronic acid 0.025mg/kg at baseline, 6 months, 12 months and 18 months

Intervention Type

Drug

Intervention Name(s)

Denosumab

Intervention Description

Subcutaneous denosumab 1.0mg/kg at baseline, 6 months, 12 months and 18 months

Primary Outcome Measure Information:

Title

The changes in serum ionized calcium levels at 48 hours following the administration of denosumab versus zoledronic acid.

Description

Time Frame

48 hours after each drug administration (48 hours post baseline and 48 hours post 6, 12 and 18 month visits)

10. Eligibility

Sex

All

Minimum Age & Unit of Time

4 Years

Maximum Age & Unit of Time

16 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Subject or subject's legally acceptable representative has provided informed consent. Children aged 4 to 16 years at the time of enrolment. Children with a history of clinically significant bone fragility in the preceding 24 months, requiring the child to have ONE or more of the following clinical profiles: At least one low-trauma vertebral or long bone fracture in a child with an underlying disease known to be associated with osteoporotic fractures (e.g. glucocorticoid-treated diseases, Crohn's disease, rheumatic disorders, Duchenne muscular dystrophy, other muscular dystrophies, spinal muscular atrophy, cerebral palsy); OR At least one low-trauma vertebral or long bone fracture in the last 24 months, in a child with a known genetic osteoporotic condition such as osteogenesis imperfecta (confirmed on molecular genetic testing); OR At least one low-trauma vertebral or long bone fracture in the last 24 months, in an otherwise healthy child with a diagnosis of osteoporosis confirmed on trans-iliac bone biopsy. Trans-iliac bone biopsy is a requirement in this sub-group as per the usual standard of care, as this is the only test that will definitively confirm osteoporosis in an otherwise healthy child who does not have a genetic bone fragility condition. Exclusion Criteria: Any child for whom the treating physician feels participation is not advised. Prior treatment with an osteoporosis agent (e.g. bisphosphonate). Renal insufficiency defined as an eGFR less than 60ml/min/1.73m2. Active or prior diagnosis of malignancy or undergoing investigations for a suspected childhood cancer. Currently breastfeeding or plans to breastfeed during the study. Pregnancy (verified by pre-treatment pregnancy test in all menstruating or sexually active females). Untreated vitamin D deficiency, defined as a serum 25OHD level <50nmol/L. Untreated hypocalcemia, defined as a serum ionized calcium level <1.1mmol/L. Active or historic eczema/cellulitis. Children planning dental procedures and/or dental surgery during the course of the study. Children with a documented history of atrial fibrillation. Children with asthma who are acetylsalicylic acid (ASA) sensitive. Children that have had parathyroid or thyroid surgery. Children who are allergic to rubber or latex. Males with a pregnant partner.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Leanne Ward, MD

Organizational Affiliation

Children's Hospital of Eastern Ontario

Official's Role

Principal Investigator

Facility Information:

Facility Name

Children's Hospital of Eastern Ontario

City

Ottawa

State/Province

Ontario

ZIP/Postal Code

K1H 8L1

Country

Canada

12. IPD Sharing Statement

Plan to Share IPD

Yes

IPD Sharing Plan Description

No current plan

IPD Sharing Time Frame

No time frame

IPD Sharing Access Criteria

Access has not been made available

Learn more about this trial

Denosumab for the Treatment of Osteoporosis in Children: A Pilot Study

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