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Clinical Pharmacokinetics and Pharmacodynamics Study of Different Doses of Zoledronic Acid

Primary Purpose

Postmenopausal Osteoporosis

Status
Not yet recruiting
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Zoledronic Acid Injection
Zoledronic Acid Injection
Zoledronic Acid Injection
Placebo
Sponsored by
Peking University Third Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Postmenopausal Osteoporosis focused on measuring zoledronic acid, pharmacokinetic, pharmacodynamic, Chinese osteoporosis

Eligibility Criteria

60 Years - 70 Years (Adult, Older Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  1. Chinese postmenopausal women
  2. Aged between 60 and 70.
  3. Bone mineral density (BMD) values of less than 1 standard deviations (SD) below the normal adult mean.
  4. Willing to participate in this study.

Exclusion Criteria:

  1. Hypersensitivity to zoledronic acid or other bisphosphonate or zoledronic acid formulation (excipients).
  2. Secondary osteoporosis.
  3. Receiving the following drugs that affect bone metabolism prior to randomization:

(1) intravenous biphosphonates or denosumab. (2) oral biphosphonates, parathyroid hormone or its analogues, strontium, or fluoride within 12 months.

(3) glucocorticoid, steroids, immunosuppressive agents, calcitonin, calcitriol or its analogues, thiazides diuretics, long-acting estrogen/progesterone, or statins within 3 months.

4. Combine other diseases affect bone metabolism: osteogenesis imperfecta, hyperthyroidism, malignant tumors, Paget's disease, rheumatoid arthritis, osteomalacia, osteopetrosis, ankylosing spondylitis, liver failure, or renal failure.

5. Hyperthyroidism or hypothyroidism during screening.

6. Treatment with any investigational drug within the past 3 months.

7. Creatinine clearance < 35 mL/min.

8. 25(OH)D level< 20 ng/mL.

9. Serum calcium level < 2.0 mmol/L (8 mg/dL), or >2.8 mmol/L (11.0 mg/dL).

10. Fever, severe infections, severe injuries, or major surgical operation within 30 days.

11. ECG corrected QT interval (QTc) > 480 ms.

12. Pending invasive dental procedure or in progress.

13. History of smoking within 6 months.

14. Diabetes with fasting blood glucose ≥ 7.0 mmol/L, or glycated hemoglobin (HbA1c) >6.3%.

15. History of drug or alcohol abuse.

16. History of stroke, cerebral ischemic stroke, or cerebral hemorrhage.

17. Any physiological or medical condition which, in the opinion of the investigator, would preclude the participant from this trail.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Experimental

    Experimental

    Experimental

    Placebo Comparator

    Arm Label

    zoledronic acid 1mg

    zoledronic acid 2.5mg

    zoledronic acid 5mg

    placebo

    Arm Description

    Add 20 mL of Zoledronic acid injection (100mL : 5mg) with 80 mL of normal saline to 100 mL. Infusion 20 minutes with constant speed. Administration only once.

    Add 50 mL of Zoledronic acid injection (100mL : 5mg) with 50 mL of normal saline to 100 mL. Infusion 20 minutes with constant speed. Administration only once.

    Infusion 100 mL of Zoledronic acid injection (100mL : 5mg) with constant speed in 20 minutes. Administration only once.

    Infusion 100 mL of normal saline with constant speed in 20 minutes. Administration only once.

    Outcomes

    Primary Outcome Measures

    Concentration of Zoledronic acid
    Zoledronic acid concentration in plasma and urine.
    Maximum concentration of Zoledronic acid
    The observed maximum concentration following administration (Cmax) in plasma after zoledronic acid infusion.
    Time to reach maximum concentration of Zoledronic acid
    The time to reach the maximum concentration after administration (Tmax) in plasma after zoledronic acid infusion.
    AUC of Zoledronic acid
    The area under the concentration-time curve (AUC) in plasma after zoledronic acid infusion.
    terminal half-life of Zoledronic acid
    The terminal half-life (t1/2) of zoledronic acid after administration.
    apparent clearance of Zoledronic acid
    The apparent clearance (CL/F) of zoledronic acid after administration.
    apparent volume of distribution of Zoledronic acid
    The apparent volume of distribution of zoledronic acid after administration.
    Concentration of bone turnover markers
    Concentration-time profile of procollagen type 1 N-propeptide (P1NP), bone-specific alkaline phosphatase (ALP), osteocalcin (OCN), C-telopeptide (CTx), and tartrate-resistant acid phosphatase 5b (TRACP-5b) with unit of ng/mL.
    Concentration of 25(OH)D and FGF23
    Concentration determination of 25(OH)D and fibroblast growth factor 23 (FGF23) with unit of ng/mL
    PTH concentration determination
    Assessment of the profile of parathyroid hormone (PTH)
    Serum sclerostin concentration determination
    Concentration-time profile of sclerostin (SOST) after zoledronic acid infusion.
    Pharmacodynamic of zoledronic acid
    Assessment of lipid metabolism markers, such as low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol, and triglycerides.
    Pharmacodynamic of zoledronic acid
    Assessment of fibroblast growth factor 19 (FGF19).
    Pharmacodynamic of zoledronic acid
    Assessment of total bile acid.
    Pharmacodynamic of zoledronic acid
    Assessment of bone mineral density at the lumbar spine, neck of femur, and total hip.
    Change of immune indicator
    Changes in white blood cells(WBC)
    Change of immune indicator
    Changes in C reaction protein (CRP)
    Change of immune indicator
    Changes in interferon-γ (IFN-γ)
    Change of immune indicator
    Changes in interleukin-6 (IL-6)
    Change of immune indicator
    Changes in γδT cells activation

    Secondary Outcome Measures

    Incidence of adverse event
    The occurrence time and severity of fracture. The occurrence time and severity of acute phase response. The occurrence time and severity of other adverse event.

    Full Information

    First Posted
    January 7, 2021
    Last Updated
    June 21, 2021
    Sponsor
    Peking University Third Hospital
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04719650
    Brief Title
    Clinical Pharmacokinetics and Pharmacodynamics Study of Different Doses of Zoledronic Acid
    Official Title
    The Pharmacokinetics and Pharmacodynamics Study of Intravenous Zoledronic Acid in Chinese Subjects With Low Bone Mass or Osteoporosis: a Randomized Placebo-controlled Trail
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2021
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    October 2021 (Anticipated)
    Primary Completion Date
    October 2024 (Anticipated)
    Study Completion Date
    November 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Peking University Third Hospital

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    The recommended dosing regimen of zoledronic acid in Chinese osteoporosis patients is completely in accordance with the one of 5 mg per year abroad that based on the dosing regimen in Paget's disease. This dosing regimen lacks the actual supportive clinical data of Chinese patients. In addition, the overall incidence of acute phase response, the main adverse event after the first infusion, in Chinese patients is higher than that in Caucasian patients population. Moreover, the results of the similar drug clinical study in the Japanese patients shown that the purpose of effective treatment for osteoporosis could be achieved with half of the dosage in Caucasian population. Thus, it could be inferred from these that the dosing regimen of zoledronic acid might be inappropriate in Chinese osteoporosis patients. Therefore, the main purpose of this clinical trail is to compare the zoledronic acid pharmacokinetic and pharmacodynamic characteristic of different doses in Chinese postmenopausal subjects with low bone mass or osteoporosis and explore the best dosing regimen in Chinese patients.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Postmenopausal Osteoporosis
    Keywords
    zoledronic acid, pharmacokinetic, pharmacodynamic, Chinese osteoporosis

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantInvestigator
    Allocation
    Randomized
    Enrollment
    64 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    zoledronic acid 1mg
    Arm Type
    Experimental
    Arm Description
    Add 20 mL of Zoledronic acid injection (100mL : 5mg) with 80 mL of normal saline to 100 mL. Infusion 20 minutes with constant speed. Administration only once.
    Arm Title
    zoledronic acid 2.5mg
    Arm Type
    Experimental
    Arm Description
    Add 50 mL of Zoledronic acid injection (100mL : 5mg) with 50 mL of normal saline to 100 mL. Infusion 20 minutes with constant speed. Administration only once.
    Arm Title
    zoledronic acid 5mg
    Arm Type
    Experimental
    Arm Description
    Infusion 100 mL of Zoledronic acid injection (100mL : 5mg) with constant speed in 20 minutes. Administration only once.
    Arm Title
    placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Infusion 100 mL of normal saline with constant speed in 20 minutes. Administration only once.
    Intervention Type
    Drug
    Intervention Name(s)
    Zoledronic Acid Injection
    Other Intervention Name(s)
    Yigu
    Intervention Description
    Infusion 1mg zoledronic acid once.
    Intervention Type
    Drug
    Intervention Name(s)
    Zoledronic Acid Injection
    Other Intervention Name(s)
    Yigu
    Intervention Description
    Infusion 2.5mg zoledronic acid once.
    Intervention Type
    Drug
    Intervention Name(s)
    Zoledronic Acid Injection
    Other Intervention Name(s)
    Yigu
    Intervention Description
    Infusion 5mg zoledronic acid once.
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Other Intervention Name(s)
    Yigu Placebo
    Intervention Description
    Infusion normal saline once.
    Primary Outcome Measure Information:
    Title
    Concentration of Zoledronic acid
    Description
    Zoledronic acid concentration in plasma and urine.
    Time Frame
    Predose, 30 minutes, 2 hours, 24 hours, day 7, day 29, 3 months, 6 months, 12 months, 24 months, and 36 months post dose
    Title
    Maximum concentration of Zoledronic acid
    Description
    The observed maximum concentration following administration (Cmax) in plasma after zoledronic acid infusion.
    Time Frame
    0-36 months
    Title
    Time to reach maximum concentration of Zoledronic acid
    Description
    The time to reach the maximum concentration after administration (Tmax) in plasma after zoledronic acid infusion.
    Time Frame
    0-36 months
    Title
    AUC of Zoledronic acid
    Description
    The area under the concentration-time curve (AUC) in plasma after zoledronic acid infusion.
    Time Frame
    0-36 months
    Title
    terminal half-life of Zoledronic acid
    Description
    The terminal half-life (t1/2) of zoledronic acid after administration.
    Time Frame
    0-36 months
    Title
    apparent clearance of Zoledronic acid
    Description
    The apparent clearance (CL/F) of zoledronic acid after administration.
    Time Frame
    0-36 months
    Title
    apparent volume of distribution of Zoledronic acid
    Description
    The apparent volume of distribution of zoledronic acid after administration.
    Time Frame
    0-36 months
    Title
    Concentration of bone turnover markers
    Description
    Concentration-time profile of procollagen type 1 N-propeptide (P1NP), bone-specific alkaline phosphatase (ALP), osteocalcin (OCN), C-telopeptide (CTx), and tartrate-resistant acid phosphatase 5b (TRACP-5b) with unit of ng/mL.
    Time Frame
    0-36 months
    Title
    Concentration of 25(OH)D and FGF23
    Description
    Concentration determination of 25(OH)D and fibroblast growth factor 23 (FGF23) with unit of ng/mL
    Time Frame
    0-36 months
    Title
    PTH concentration determination
    Description
    Assessment of the profile of parathyroid hormone (PTH)
    Time Frame
    0-36 months
    Title
    Serum sclerostin concentration determination
    Description
    Concentration-time profile of sclerostin (SOST) after zoledronic acid infusion.
    Time Frame
    0-36 months
    Title
    Pharmacodynamic of zoledronic acid
    Description
    Assessment of lipid metabolism markers, such as low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol, and triglycerides.
    Time Frame
    0-36 months
    Title
    Pharmacodynamic of zoledronic acid
    Description
    Assessment of fibroblast growth factor 19 (FGF19).
    Time Frame
    0-36 months
    Title
    Pharmacodynamic of zoledronic acid
    Description
    Assessment of total bile acid.
    Time Frame
    0-36 months
    Title
    Pharmacodynamic of zoledronic acid
    Description
    Assessment of bone mineral density at the lumbar spine, neck of femur, and total hip.
    Time Frame
    0-36 months
    Title
    Change of immune indicator
    Description
    Changes in white blood cells(WBC)
    Time Frame
    0-36 months
    Title
    Change of immune indicator
    Description
    Changes in C reaction protein (CRP)
    Time Frame
    0-36 months
    Title
    Change of immune indicator
    Description
    Changes in interferon-γ (IFN-γ)
    Time Frame
    0-36 months
    Title
    Change of immune indicator
    Description
    Changes in interleukin-6 (IL-6)
    Time Frame
    0-36 months
    Title
    Change of immune indicator
    Description
    Changes in γδT cells activation
    Time Frame
    0-36 months
    Secondary Outcome Measure Information:
    Title
    Incidence of adverse event
    Description
    The occurrence time and severity of fracture. The occurrence time and severity of acute phase response. The occurrence time and severity of other adverse event.
    Time Frame
    0-36 months

    10. Eligibility

    Sex
    Female
    Gender Based
    Yes
    Minimum Age & Unit of Time
    60 Years
    Maximum Age & Unit of Time
    70 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Chinese postmenopausal women Aged between 60 and 70. Bone mineral density (BMD) values of less than 1 standard deviations (SD) below the normal adult mean. Willing to participate in this study. Exclusion Criteria: Hypersensitivity to zoledronic acid or other bisphosphonate or zoledronic acid formulation (excipients). Secondary osteoporosis. Receiving the following drugs that affect bone metabolism prior to randomization: (1) intravenous biphosphonates or denosumab. (2) oral biphosphonates, parathyroid hormone or its analogues, strontium, or fluoride within 12 months. (3) glucocorticoid, steroids, immunosuppressive agents, calcitonin, calcitriol or its analogues, thiazides diuretics, long-acting estrogen/progesterone, or statins within 3 months. 4. Combine other diseases affect bone metabolism: osteogenesis imperfecta, hyperthyroidism, malignant tumors, Paget's disease, rheumatoid arthritis, osteomalacia, osteopetrosis, ankylosing spondylitis, liver failure, or renal failure. 5. Hyperthyroidism or hypothyroidism during screening. 6. Treatment with any investigational drug within the past 3 months. 7. Creatinine clearance < 35 mL/min. 8. 25(OH)D level< 20 ng/mL. 9. Serum calcium level < 2.0 mmol/L (8 mg/dL), or >2.8 mmol/L (11.0 mg/dL). 10. Fever, severe infections, severe injuries, or major surgical operation within 30 days. 11. ECG corrected QT interval (QTc) > 480 ms. 12. Pending invasive dental procedure or in progress. 13. History of smoking within 6 months. 14. Diabetes with fasting blood glucose ≥ 7.0 mmol/L, or glycated hemoglobin (HbA1c) >6.3%. 15. History of drug or alcohol abuse. 16. History of stroke, cerebral ischemic stroke, or cerebral hemorrhage. 17. Any physiological or medical condition which, in the opinion of the investigator, would preclude the participant from this trail.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Qi Liu, Ph. D.
    Phone
    +8615501060136
    Email
    liuqicpu@hotmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Chunli Song, M.D.; Ph. D.
    Organizational Affiliation
    Peking University Third Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    25182228
    Citation
    Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. doi: 10.1007/s00198-014-2794-2. Epub 2014 Aug 15. Erratum In: Osteoporos Int. 2015 Jul;26(7):2045-7.
    Results Reference
    background
    PubMed Identifier
    12730746
    Citation
    Shiraki M, Fukunaga M, Kushida K, Kishimoto H, Taketani Y, Minaguchi H, Inoue T, Morita R, Morii H, Yamamoto K, Ohashi Y, Orimo H. A double-blind dose-ranging study of risedronate in Japanese patients with osteoporosis (a study by the Risedronate Late Phase II Research Group). Osteoporos Int. 2003 May;14(3):225-34. doi: 10.1007/s00198-002-1369-9. Epub 2003 Apr 10.
    Results Reference
    background
    PubMed Identifier
    28960821
    Citation
    Ding Y, Zeng JC, Yin F, Zhang CL, Zhang Y, Li SX, Liu X, Zhang C, Xue QY, Lin H, Pei FX. Multicenter Study on Observation of Acute-phase Responses After Infusion of Zoledronic Acid 5 mg in Chinese Women with Postmenopausal Osteoporosis. Orthop Surg. 2017 Aug;9(3):284-289. doi: 10.1111/os.12338.
    Results Reference
    background

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    Clinical Pharmacokinetics and Pharmacodynamics Study of Different Doses of Zoledronic Acid

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