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The Efficacy of Denosumab in Incomplete Patients Spinal Cord Injury

Primary Purpose

Secondary Osteoporosis, Spinal Cord Injury

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Denosumab (Prolia)
Placebo (normal saline)
Sponsored by
James J. Peters Veterans Affairs Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Secondary Osteoporosis focused on measuring Spinal Cord Injury, Denosumab, Osteoporosis, Dual Energy X-ray Absorptiometry

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Motor incomplete SCI [American Spinal Injury Association Impairment Scale (AIS) grades C and D];
  2. Duration of injury < 6-months; and
  3. Males between the ages of 18 and 65 years old and females between the ages of 18 and 50 years old.

Exclusion Criteria:

  1. Extensive life-threatening injuries in addition to SCI;
  2. Acute fracture or extensive bone trauma;
  3. History of prior bone disease (Paget's hyperparathyroidism, osteoporosis, etc.)
  4. Post-menopausal women;
  5. Men with known hypogonadism prior to SCI;
  6. Anabolic or Steroid hormonal therapy; within the past year and longer than six months;
  7. Hyperthyroidism;
  8. Cushing's disease or syndrome;
  9. Severe underlying chronic disease;
  10. History of chronic alcohol abuse;
  11. Diagnosis of Hypocalcemia;
  12. Pregnancy;
  13. Existing dental condition/dental infection;
  14. Diagnosis of heterotopic ossification at the hip and/or knee region and receiving a bisphosphonates [e.g. alendronate sodium (Fosamax) or etidronate disodium (Didronel)] that will no longer make participants eligible to receive the study medication/placebo but are still eligible to complete follow-up outcome measures as described in the work schedule;
  15. Current diagnosis of cancer or history of cancer; and
  16. Any patient receiving moderate or high dose corticosteroids (>40 mg/d prednisone or an equivalent dose of other corticosteroid) for longer than one week, not including drug administered in an attempt to preserve neurological function at the time of acute SCI.

Sites / Locations

  • Kessler Institute for Rehabilitation
  • James J. Peters VA Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Placebo Comparator

Experimental

Placebo Comparator

Arm Label

Denosumab, AIS Grade C (non-ambulatory)

Placebo, AIS Grade C (non-ambulatory)

Denosumab, AIS Grade D (ambulatory)

Placebo, AIS Grade D (ambulatory)

Arm Description

8 subjects with AIS grade C will be randomized to receive Denosumab (Prolia 120mg SC) administered at baseline and 6 months.

8 subjects with AIS grade C will be randomized to the placebo group and will receive the identical volume of normal saline at parallel time points.

8 subjects with AIS grade D will be randomized to receive Denosumab (Prolia 120mg SC) administered at baseline and 6 months.

8 subjects with AIS grade D will be randomized to the placebo group and will receive the identical volume of normal saline at parallel time points.

Outcomes

Primary Outcome Measures

areal bone mineral density (aBMD) by dual energy X-ray absorptiometry (DXA)
Efficacy of denosumab to prevent aBMD loss at the distal femur and proximal tibia

Secondary Outcome Measures

volumetric BMD (vBMD) and microarchitecture by peripheral quantitative computed tomography
Efficacy of denosumab to prevent vBMD loss and microarchitecture deterioration at the distal femur and proximal tibia

Full Information

First Posted
January 20, 2017
Last Updated
March 6, 2019
Sponsor
James J. Peters Veterans Affairs Medical Center
Collaborators
Kessler Institute for Rehabilitation
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1. Study Identification

Unique Protocol Identification Number
NCT03029442
Brief Title
The Efficacy of Denosumab in Incomplete Patients Spinal Cord Injury
Official Title
The Efficacy of Denosumab to Prevent Bone Loss in Ambulatory and Non-ambulatory Motor-Incomplete Patients With Subacute Spinal Cord Injury
Study Type
Interventional

2. Study Status

Record Verification Date
March 2019
Overall Recruitment Status
Recruiting
Study Start Date
April 1, 2017 (Actual)
Primary Completion Date
December 2021 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
James J. Peters Veterans Affairs Medical Center
Collaborators
Kessler Institute for Rehabilitation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine the usefulness of a drug, denosumab, to prevent the loss of bone in participants legs due to SCI. This drug is FDA approved to treat osteoporosis in women after menopause who have an increased risk for fractures, to treat women receiving certain treatments for breast cancer who have an increased risk of fractures, and to treat bone loss in men receiving certain treatments for prostate cancer who have increased risk for fractures. This drug is considered experimental for the purpose of this study. Study participation will last for approximately 12 months (6 study visits total), visits will range from1-4.5 hours depending on the number of tests that need to be completed. The study is a double-blinded placebo trail in which the participant will be randomly assigned to on of two groups, Denosumab injections or placebo - inactive salt solution injections.
Detailed Description
The primary objective of this study is to test the efficacy of a potent anti-resorptive agent, denosumab [receptor activator of nuclear factor-κB ligand (RANKL) antibody; Amgen Inc.] to preserve bone mass at the hip and knee and trabecular connectivity at the knee after subacute motor-incomplete SCI [American Spinal Injury Association (AIS) neurological classification scale C and D] at the James J. Peters VA Medical Center (JJPVAMC) and Kessler Institute for Rehabilitation (KIR). A randomized, double-blind, placebo-controlled, parallel group trial will be performed in thirty-two subjects with acute, motor-incomplete SCI (≤6 months) who have been admitted to JJPVAMC or the KIR. Denosumab (60 mg SC) will be administered at baseline, 6, and 12 months; the placebo group will receive normal saline subcutaneously. Denosumab will be administered as soon as possible, but up to 24 weeks, after SCI. The last dose of denosumab and placebo will be administered at 6 months, with the anticipated effect of the drug to persist and inhibit bone resorption at least until the 12 month time point.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Secondary Osteoporosis, Spinal Cord Injury
Keywords
Spinal Cord Injury, Denosumab, Osteoporosis, Dual Energy X-ray Absorptiometry

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
32 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Denosumab, AIS Grade C (non-ambulatory)
Arm Type
Experimental
Arm Description
8 subjects with AIS grade C will be randomized to receive Denosumab (Prolia 120mg SC) administered at baseline and 6 months.
Arm Title
Placebo, AIS Grade C (non-ambulatory)
Arm Type
Placebo Comparator
Arm Description
8 subjects with AIS grade C will be randomized to the placebo group and will receive the identical volume of normal saline at parallel time points.
Arm Title
Denosumab, AIS Grade D (ambulatory)
Arm Type
Experimental
Arm Description
8 subjects with AIS grade D will be randomized to receive Denosumab (Prolia 120mg SC) administered at baseline and 6 months.
Arm Title
Placebo, AIS Grade D (ambulatory)
Arm Type
Placebo Comparator
Arm Description
8 subjects with AIS grade D will be randomized to the placebo group and will receive the identical volume of normal saline at parallel time points.
Intervention Type
Drug
Intervention Name(s)
Denosumab (Prolia)
Other Intervention Name(s)
Xgeva
Intervention Description
In clinical trials, denosumab (Amgen Inc., Thousand Oaks, CA), has been shown to be more potent in reducing osteoclastosis and function than bisphosphonates. The dose of denosumab chosen for our protocol in patients after acute SCI will be the same dose that has been shown to be efficacious to treat postmenopausal osteoporosis (60 mg SQ q 6 months).
Intervention Type
Other
Intervention Name(s)
Placebo (normal saline)
Intervention Description
Identical Denosumab volume of normal saline
Primary Outcome Measure Information:
Title
areal bone mineral density (aBMD) by dual energy X-ray absorptiometry (DXA)
Description
Efficacy of denosumab to prevent aBMD loss at the distal femur and proximal tibia
Time Frame
Prior to denosumab or placebo administration and 18 months after denosumab or placebo administration
Secondary Outcome Measure Information:
Title
volumetric BMD (vBMD) and microarchitecture by peripheral quantitative computed tomography
Description
Efficacy of denosumab to prevent vBMD loss and microarchitecture deterioration at the distal femur and proximal tibia
Time Frame
Prior to denosumab or placebo administration and 12 months after denosumab or placebo administration

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Motor incomplete SCI [American Spinal Injury Association Impairment Scale (AIS) grades C and D]; Duration of injury < 6-months; and Males between the ages of 18 and 65 years old and females between the ages of 18 and 50 years old. Exclusion Criteria: Extensive life-threatening injuries in addition to SCI; Acute fracture or extensive bone trauma; History of prior bone disease (Paget's hyperparathyroidism, osteoporosis, etc.) Post-menopausal women; Men with known hypogonadism prior to SCI; Anabolic or Steroid hormonal therapy; within the past year and longer than six months; Hyperthyroidism; Cushing's disease or syndrome; Severe underlying chronic disease; History of chronic alcohol abuse; Diagnosis of Hypocalcemia; Pregnancy; Existing dental condition/dental infection; Diagnosis of heterotopic ossification at the hip and/or knee region and receiving a bisphosphonates [e.g. alendronate sodium (Fosamax) or etidronate disodium (Didronel)] that will no longer make participants eligible to receive the study medication/placebo but are still eligible to complete follow-up outcome measures as described in the work schedule; Current diagnosis of cancer or history of cancer; and Any patient receiving moderate or high dose corticosteroids (>40 mg/d prednisone or an equivalent dose of other corticosteroid) for longer than one week, not including drug administered in an attempt to preserve neurological function at the time of acute SCI.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Christopher M Cirnigliaro, M.S.
Phone
973-731-3900
Ext
2755
Email
christopher.cirnigliaro@va.gov
First Name & Middle Initial & Last Name or Official Title & Degree
William A Bauman, M.D.
Phone
718-584-9000
Ext
5428
Email
william.bauman@va.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William A Bauman, M.D.
Organizational Affiliation
James J. Peters VA Medical Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Steven C Kirshblum, M.D.
Organizational Affiliation
Kessler Institute for Rehabilitation
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kessler Institute for Rehabilitation
City
West Orange
State/Province
New Jersey
ZIP/Postal Code
07052
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Christopher M Cirnigliaro, M.S.
Phone
973-731-3900
Ext
2755
Email
christopher.cirnigliaro@gmail.com
First Name & Middle Initial & Last Name & Degree
Steven C Kirshblum, M.D.
Phone
973-731-3900
Ext
2258
Email
skirshblum@kessler-rehab.com
First Name & Middle Initial & Last Name & Degree
Christopher M Cirniliaro, M.S.
First Name & Middle Initial & Last Name & Degree
Steven C Kirshblum, M.D.
Facility Name
James J. Peters VA Medical Center
City
Bronx
State/Province
New York
ZIP/Postal Code
10468
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joshua C Hobson, M.S.
Phone
718-584-9000
Ext
3129
Email
joshua.hobson@va.gov

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
An IPD is not desired by the investigators and is not part of the regulatory guidelines at the participating institutions
Citations:
PubMed Identifier
26423406
Citation
Gifre L, Vidal J, Carrasco JL, Muxi A, Portell E, Monegal A, Guanabens N, Peris P. Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury. Osteoporos Int. 2016 Jan;27(1):405-10. doi: 10.1007/s00198-015-3333-5. Epub 2015 Sep 30.
Results Reference
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The Efficacy of Denosumab in Incomplete Patients Spinal Cord Injury

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