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Safety and Tolerability of Intravenous LLP2A-Alendronate for Osteopenia Secondary to Glucocorticoids

Primary Purpose

Osteopenia, Osteoporosis, Osteonecrosis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
LLP2A-ALENDRONATE
Placebo
Sponsored by
Nancy E. Lane, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Osteopenia focused on measuring Glucocorticoids

Eligibility Criteria

20 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Subjects must meet all of the following criteria to be included in the study.

  1. 20 - 85 years old
  2. Receiving 5 - 40 mg/day prednisone, or equivalent of another GC (methylprednisolone 4 mg/day, or prednisone 10 mg every other day) for a minimum of 4 consecutive weeks prior to enrollment
  3. Anticipated to continue to receive at least 5 mg/day prednisone or equivalent throughout study participation
  4. T score ≤ -1.0 in the femoral neck or total hip or lumbosacral spine. Only one result from one of these locations that is ≤ -1.0 is required. For screening DXA, a DXA completed within 6 months of screening may be used; otherwise DXA must be completed within 4 weeks of screening visit.
  5. Must be ambulatory and able to attend all appointments
  6. Women must agree to use one of the following methods of birth control for the duration of the clinical trial: systemic hormonal contraceptive (oral, injected, transdermal), intrauterine device, double barrier (e.g., cervical cap or diaphragm with condom or spermicide). Men with female partners must agree to use double barrier contraception, unless their partner is using systemic hormonal contraceptives or has an intrauterine device.
  7. In the opinion of the investigator, the concurrent medical conditions of the study subject are stable
  8. Subject undergoing PET/CT scans must have the ability to lay motionless for up to 30-45 minutes
  9. Anticipated to continue to receive all chronic medications without dose changes throughout study participation
  10. Subjects undergoing PET/CT scans must have the ability to lay motionless for up to 30-45 minutes

Exclusion Criteria:

Subjects who meet any of the following criteria will be excluded from the study:

  1. Weight greater than the limit of the DXA table at the clinical site
  2. History or concurrent conditions that might place the subject at increased risk, such as renal insufficiency (CKD 4 or 5), glomerulonephritis, atypical infections due to impaired immunity, hypersensitivity to multiple IV medications
  3. History of or concurrent presence of medical conditions which might interfere with ability to participate for the duration of the study, such as clinically significant cardiovascular disease, uncontrollable hypertension, uncontrolled asthma, symptomatic pulmonary fibrosis, recent GI bleeding requiring transfusion, psychosis, substance abuse or hospital admission within 6 months of enrollment (except for elective procedures)
  4. Prior use or current need for prohibited concomitant medications
  5. Rheumatic disease with clinically significant renal or central nervous system involvement
  6. History of deep vein thrombosis (DVT) along with taking any prophylaxis/treatment that occurred within the last 5 years
  7. History of clinically significant atrial fibrillation and/or taking medications for its treatment and prevention
  8. Unable or unwilling to comply with restrictions on alcohol 9. Previous hypersensitivity to alendronate

10. Any of the following on Screening laboratory tests:

  1. Total calcium values outside the normal range (corrected if albumin < lower limit of normal (LLN))
  2. Phosphate level < LLN
  3. 25-hydroxyvitamin D (25-OH Vitamin D) below 10ng/mL
  4. TSH > upper limit of normal (ULN)
  5. Hepatic enzymes (ALT, AST, GGT) > 1.5 X ULN
  6. Creatinine clearance (eGRF) <35 mL/min/1.73 m2 using the Modification of Diet in Renal Disease (MDRD) formula
  7. Hemoglobin <10 g/dL
  8. Positive serology for HIV, Hepatitis B or C
  9. Positive pregnancy test
  10. Prolonged QTc interval (QTcF (Fredericia) of > 450 msec for men, > 470 msec for women)
  11. Any other clinically significant laboratory value as judged by the investigator 11. Subject cannot enroll in MAD part of study until after 60 days of completing SAD part of study 12. Subjects undergoing PET/CT scans must not be breast-feeding 13. History of hypersensitivity to fluoride

Sites / Locations

  • West Coast Clinical Trials (WCCT)
  • Diablo Clinical Research
  • Altoona Center for Clinical Research
  • Metroplex Clinical Research Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

LLP2A-ALENDRONATE

Placebo

Arm Description

50, 150, 400, 750 or 1200 μg/kg or placebo given as a one time intravenous administration over 120 minutes.

Placebo given as a one time intravenous administration over 120 minutes.

Outcomes

Primary Outcome Measures

Dose limiting Adverse events
Incidence of dose limiting or intolerable treatment related adverse events (AEs) including A serious drug-related adverse event in ≥ 1 subject receiving LLP2A-Ale and/or Severe drug related adverse events in ≥ 2 subjects receiving LLP2A-Ale

Secondary Outcome Measures

Severe infusion reactions
Fever, myalgia, nausea/vomit, headache, flu like symptoms in ≥ 2 subjects receiving LLP2A-Ale
Grade 2 elevated creatinine
serum creatinine greater than 1.5 - 3.0 x baseline; greater than 1.5 - 3.0 x upper limit of normal (CTCAE v4.0) in ≥ 1 patient.

Full Information

First Posted
April 19, 2017
Last Updated
August 4, 2021
Sponsor
Nancy E. Lane, MD
Collaborators
California Institute for Regenerative Medicine (CIRM)
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1. Study Identification

Unique Protocol Identification Number
NCT03197623
Brief Title
Safety and Tolerability of Intravenous LLP2A-Alendronate for Osteopenia Secondary to Glucocorticoids
Official Title
A Phase 1, Randomized, Double-Blind, Placebo-Controlled Single and Multiple Ascending Dose Study of the Safety and Tolerability of Intravenous LLP2A-Alendronate in Adult Men and Women With Osteopenia Secondary to Glucocorticoids
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
October 14, 2016 (Actual)
Primary Completion Date
March 15, 2021 (Actual)
Study Completion Date
March 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Nancy E. Lane, MD
Collaborators
California Institute for Regenerative Medicine (CIRM)

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
A Phase 1 Randomized, Double-Blind, Placebo-Controlled Single and Multiple Ascending Dose Study of the Safety and Tolerability of Intravenous LLP2A-Alendronate in Adult Men and Women with Osteopenia Secondary to Corticosteroids
Detailed Description
The study is designed to evaluate safety and tolerability of LLP2A-Ale beginning with a single ascending dose (SAD) cohort followed by multiple ascending dose (MAD) cohorts with matching placebo in each cohort. The population in this study includes patients with low bone density (osteopenia with a T score ≤ -1.0) in the femoral neck, total hip or lumbosacral spine who are taking Corticosteroids. Up to 59 patients will be enrolled, 32 in the SAD and 27 in the MAD. LLP2A-Ale is a novel anabolic agent. It appears that LLP2A-Ale may have utility in a variety of conditions where new bone formation is required. Non-traumatic osteonecrosis (ON) has been selected as the first indication for LLP2A-Ale because of the high unmet need, absence of treatments besides surgical joint replacement, and the clear need to attract and stimulate differentiation of stem cells into the region of necrotic bone. However, osteonecrosis is a rare, sporadic disease. Therefore, the Phase 1 study is being performed in people at risk for osteonecrosis, as a population representative of people with osteonecrosis, who will be the participants in any subsequent Phase 2 and 3 studies. Non-traumatic ON may also be caused by a variety of underlying medical conditions. Glucocorticoid use, alcohol, and smoking contribute to up to 80% of cases of nontraumatic ON. The relationship to GC is the strongest in people receiving relatively long term therapy, with risk increasing with cumulative exposure over three or more months. Vasculitis from autoimmune diseases predisposes to ON and ON is particularly associated with Systemic Lupus Erythematous (SLE), possibly due to coexistence of vasculitis and chronic GC treatment. In different series, symptomatic ON is reported in about 5-30% of SLE patients. Because many foci of ON are asymptomatic, rates based on MRI surveillance are higher, in the range of 30 - 50%, and often are multifocal. Because of the particularly high incidence of ON in SLE we anticipate that SLE patients will be a significant component of the population in later trials. Therefore investigators in this Phase 1 trial include rheumatologists in order to increase the likelihood of inclusion of lupus patients in this first study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteopenia, Osteoporosis, Osteonecrosis
Keywords
Glucocorticoids

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
Randomized, Double-Blind, Placebo-Controlled Single and Multiple Ascending Dose Study
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
58 (Actual)

8. Arms, Groups, and Interventions

Arm Title
LLP2A-ALENDRONATE
Arm Type
Experimental
Arm Description
50, 150, 400, 750 or 1200 μg/kg or placebo given as a one time intravenous administration over 120 minutes.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo given as a one time intravenous administration over 120 minutes.
Intervention Type
Drug
Intervention Name(s)
LLP2A-ALENDRONATE
Other Intervention Name(s)
LLP2A-Ale
Intervention Description
A small molecule, LLP2A-Ale that directs endogenous mesenchymal stem cells (MSCs), the cells that have the potential to grow bone tissue, to the bone surface to form new bone. Single administration of LLP2A-Ale given intravenously over 120 minutes.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo, one time single administration given intravenously over 120 minutes.
Primary Outcome Measure Information:
Title
Dose limiting Adverse events
Description
Incidence of dose limiting or intolerable treatment related adverse events (AEs) including A serious drug-related adverse event in ≥ 1 subject receiving LLP2A-Ale and/or Severe drug related adverse events in ≥ 2 subjects receiving LLP2A-Ale
Time Frame
Duration of the Study, average of 4 years
Secondary Outcome Measure Information:
Title
Severe infusion reactions
Description
Fever, myalgia, nausea/vomit, headache, flu like symptoms in ≥ 2 subjects receiving LLP2A-Ale
Time Frame
Duration of the study, average of 4 years
Title
Grade 2 elevated creatinine
Description
serum creatinine greater than 1.5 - 3.0 x baseline; greater than 1.5 - 3.0 x upper limit of normal (CTCAE v4.0) in ≥ 1 patient.
Time Frame
Duration of the study, average of 4 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must meet all of the following criteria to be included in the study. 20 - 85 years old Receiving 5 - 40 mg/day prednisone, or equivalent of another GC (methylprednisolone 4 mg/day, or prednisone 10 mg every other day) for a minimum of 4 consecutive weeks prior to enrollment Anticipated to continue to receive at least 5 mg/day prednisone or equivalent throughout study participation T score ≤ -1.0 in the femoral neck or total hip or lumbosacral spine. Only one result from one of these locations that is ≤ -1.0 is required. For screening DXA, a DXA completed within 6 months of screening may be used; otherwise DXA must be completed within 4 weeks of screening visit. Must be ambulatory and able to attend all appointments Women must agree to use one of the following methods of birth control for the duration of the clinical trial: systemic hormonal contraceptive (oral, injected, transdermal), intrauterine device, double barrier (e.g., cervical cap or diaphragm with condom or spermicide). Men with female partners must agree to use double barrier contraception, unless their partner is using systemic hormonal contraceptives or has an intrauterine device. In the opinion of the investigator, the concurrent medical conditions of the study subject are stable Subject undergoing PET/CT scans must have the ability to lay motionless for up to 30-45 minutes Anticipated to continue to receive all chronic medications without dose changes throughout study participation Subjects undergoing PET/CT scans must have the ability to lay motionless for up to 30-45 minutes Exclusion Criteria: Subjects who meet any of the following criteria will be excluded from the study: Weight greater than the limit of the DXA table at the clinical site History or concurrent conditions that might place the subject at increased risk, such as renal insufficiency (CKD 4 or 5), glomerulonephritis, atypical infections due to impaired immunity, hypersensitivity to multiple IV medications History of or concurrent presence of medical conditions which might interfere with ability to participate for the duration of the study, such as clinically significant cardiovascular disease, uncontrollable hypertension, uncontrolled asthma, symptomatic pulmonary fibrosis, recent GI bleeding requiring transfusion, psychosis, substance abuse or hospital admission within 6 months of enrollment (except for elective procedures) Prior use or current need for prohibited concomitant medications Rheumatic disease with clinically significant renal or central nervous system involvement History of deep vein thrombosis (DVT) along with taking any prophylaxis/treatment that occurred within the last 5 years History of clinically significant atrial fibrillation and/or taking medications for its treatment and prevention Unable or unwilling to comply with restrictions on alcohol 9. Previous hypersensitivity to alendronate 10. Any of the following on Screening laboratory tests: Total calcium values outside the normal range (corrected if albumin < lower limit of normal (LLN)) Phosphate level < LLN 25-hydroxyvitamin D (25-OH Vitamin D) below 10ng/mL TSH > upper limit of normal (ULN) Hepatic enzymes (ALT, AST, GGT) > 1.5 X ULN Creatinine clearance (eGRF) <35 mL/min/1.73 m2 using the Modification of Diet in Renal Disease (MDRD) formula Hemoglobin <10 g/dL Positive serology for HIV, Hepatitis B or C Positive pregnancy test Prolonged QTc interval (QTcF (Fredericia) of > 450 msec for men, > 470 msec for women) Any other clinically significant laboratory value as judged by the investigator 11. Subject cannot enroll in MAD part of study until after 60 days of completing SAD part of study 12. Subjects undergoing PET/CT scans must not be breast-feeding 13. History of hypersensitivity to fluoride
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nancy E Lane, MD
Organizational Affiliation
UC Davis Health
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Nancy E Lane, MD
Organizational Affiliation
UC Davis Health
Official's Role
Study Director
Facility Information:
Facility Name
West Coast Clinical Trials (WCCT)
City
Cypress
State/Province
California
ZIP/Postal Code
92626
Country
United States
Facility Name
Diablo Clinical Research
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States
Facility Name
Altoona Center for Clinical Research
City
Duncansville
State/Province
Pennsylvania
ZIP/Postal Code
16635
Country
United States
Facility Name
Metroplex Clinical Research Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Safety and Tolerability of Intravenous LLP2A-Alendronate for Osteopenia Secondary to Glucocorticoids

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