A Single-Dose Placebo-Controlled Study of AMG 162, a Fully Human Monoclonal Antibody to RANKL, in Postmenopausal Women

Oxford University Press (OUP) - Tập 19 Số 7 - Trang 1059-1066 - 2004
Pirow Bekker1,2, Donna Holloway1, Amy S Rasmussen1, Robyn Murphy1, Steven W. Martin1, Philip T. Leese3, Gregory B. Holmes4, Colin R. Dunstan5, Alex M. DePaoli1
1Amgen, Inc., Thousand Oaks, California, USA
2Drs Bekker, Holloway, Rasmussen, Murphy, Martin, and DePaoli are employees and stock holders of Amgen, Inc. Dr Dunstan received corporate appointments and stock from Amgen, Inc. All other authors have no conflict of interest
3Quintiles, Lenexa, Kansas, USA
4SFBC International, Inc., Miami, Florida, USA
5ANZAC Research Institute, Concord, New South Wales, Australia

Tóm tắt

Abstract The safety and bone antiresorptive effect of a single subcutaneous dose of AMG 162, a human monoclonal antibody to RANKL, was investigated in 49 postmenopausal women. AMG 162 is a potent antiresorptive agent for diseases such as osteoporosis. Introduction: RANKL is an essential osteoclastic differentiation and activation factor. Materials and Methods: The bone antiresorptive activity and safety of AMG 162, a fully human monoclonal antibody to RANKL, were evaluated in postmenopausal women in this randomized, double-blind, placebo-controlled, single-dose, dose escalation study. Six cohorts of eight to nine women were randomly assigned to receive a single subcutaneous injection of either AMG 162 or placebo (3:1 ratio). AMG 162 doses were 0.01, 0.03, 0.1, 0.3, 1.0, and 3.0 mg/kg. Subjects were followed up to 6 months in all cohorts and 9 months in the three highest dose cohorts. Second morning void urinary N-telopeptide/creatinine (NTX; Osteomark), serum NTX, and serum bone-specific alkaline phosphatase (BALP, Ostase) were assessed as bone turnover markers. Results and Conclusions: Forty-nine women were enrolled. A single subcutaneous dose of AMG 162 resulted in a dose-dependent, rapid (within 12 h), profound (up to 84%), and sustained (up to 6 months) decrease in urinary NTX. At 6 months, there was a mean change from baseline of −81% in the 3.0 mg/kg AMG 162 group compared with −10% in the placebo group; serum NTX changes were −56% and 2%, respectively. BALP levels did not decrease remarkably until after 1 month, indicating that the effect of AMG 162 is primarily antiresorptive. Intact parathyroid hormone (PTH) levels increased up to ∼3-fold after 4 days in the 3.0 mg/kg dose group, but returned toward baseline with follow-up. Albumin-adjusted serum calcium did not decrease >10% on average in any group, and no subject had values below 2 mmol/liter. AMG 162 was well tolerated. No related serious adverse events occurred. No clinically meaningful laboratory changes, other than those described above, were observed. In summary, a single subcutaneous dose of AMG 162 resulted in a dose-dependent rapid and sustained decrease from baseline in bone turnover and could be an effective and convenient treatment for osteoporosis.

Từ khóa


Tài liệu tham khảo

Anderson, 1997, A homologue of the TNF receptor and its ligand enhance T-cell growth and dendritic-cell function, Nature, 390, 175, 10.1038/36593

Lacey, 1998, Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation, Cell, 93, 165, 10.1016/S0092-8674(00)81569-X

Yasuda, 1998, Osteoclast differentiation factor is a ligand for osteoprotegerin/osteoclastogenesis-inhibitory factor and is identical to TRANCE/RANKL, Proc Natl Acad Sci USA, 95, 3597, 10.1073/pnas.95.7.3597

Burgess, 1999, The ligand for osteoprotegerin (OPGL) directly activates mature osteoclasts, J Cell Biol, 145, 527, 10.1083/jcb.145.3.527

Kong, 1999, OPGL is a key regulator of osteoclastogenesis, lymphocyte development and lymph-node organogenesis, Nature, 397, 315, 10.1038/16852

Simonet, 1997, Osteoprotegerin: A novel secreted protein involved in the regulation of bone density, Cell, 89, 309, 10.1016/S0092-8674(00)80209-3

Tsuda, 1997, Isolation of a novel cytokine from human fibroblasts that specifically inhibits osteoclastogenesis, Biochim Biophys Res Commun, 234, 137, 10.1006/bbrc.1997.6603

Bekker, 2001, The effect of a single dose of osteoprotegerin in postmenopausal women, J Bone Miner Res, 16, 348, 10.1359/jbmr.2001.16.2.348

Body, 2003, A phase I study of AMGN-0007, a recombinant osteoprotegerin construct, in patients with multiple myeloma or breast carcinoma related bone metastases, Cancer, 97, 887, 10.1002/cncr.11138

Bucay, 1998, Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification, Genes Dev, 12, 1260, 10.1101/gad.12.9.1260

Kostenuik, 2001, OPG and PTH-(1–34) have additive effects on bone density and mechanical strength in osteopenic ovariectomized rats, Endocrine, 142, 4295, 10.1210/endo.142.10.8437

Croucher, 2001, Osteoprotegerin inhibits the development of osteolytic bone disease in multiple myeloma, Blood, 98, 3534, 10.1182/blood.V98.13.3534

Sezer, 2003, RANK ligand and osteoprotegerin in myeloma bone disease, Blood, 101, 2094, 10.1182/blood-2002-09-2684

Roux, 2002, RANK (receptor activator of nuclear factor-kappaB) and RANKL expression in multiple myeloma, Brit J Haematol, 117, 86, 10.1046/j.1365-2141.2002.03417.x

Thomas, 1999, Breast cancer cells interact with osteoblasts to support osteoclast formation, Endocrine, 140, 4451, 10.1210/endo.140.10.7037

Mancino, 2001, Breast cancer increases osteoclastogenesis by secreting M-CSF and upregulating RANKL in stromal cells, J Surg Res, 100, 18, 10.1006/jsre.2001.6204

Morony, 1999, A chimeric form of osteoprotegerin inhibits hypercalcemia and bone resorption induced by IL-1 beta, TNF-alpha, PTH, PTHrP, and 1,25(OH)(2)D-3, J Bone Miner Res, 14, 1478, 10.1359/jbmr.1999.14.9.1478

Kitazawa, 2002, RANK ligand is a prerequisite for cancer-associated osteolytic lesions, J Pathol, 198, 228, 10.1002/path.1199

Brown, 2001, Osteoprotegerin and RANK ligand expression in prostate cancer, Urology, 57, 611, 10.1016/S0090-4295(00)01122-5

Zhang, 2001, Osteoprotegerin inhibits prostate cancer-induced osteoclastogenesis and prevents prostate tumor growth in the bone, J Clin Invest, 107, 1235, 10.1172/JCI11685

Honore, 2000, Osteoprotegerin blocks bone cancer-induced skeletal destruction, skeletal pain and pain-related neurochemical reorganization of the spinal cord, Nat Med, 6, 521, 10.1038/74999

Mantyh, 2002, Molecular mechanisms of cancer pain, Nature Rev Cancer, 2, 201, 10.1038/nrc747

Clohisy, 2000, Osteoprotegerin inhibits tumor-induced osteoclastogenesis and bone tumor growth in osteopetrotic mice, J Orthop Res, 18, 967, 10.1002/jor.1100180617

Luger, 2001, Osteoprotegerin diminishes advanced bone cancer pain, Cancer Res, 61, 4038

Kong, 1999, Activated T cells regulate bone loss and joint destruction in adjuvant arthritis through osteoprotegerin ligand, Nature, 402, 304, 10.1038/46303

Romas, 2002, Osteoprotegerin reduces osteoclast numbers and prevents bone erosion in collagen-induced arthritis, Am J Pathol, 161, 1419, 10.1016/S0002-9440(10)64417-3

Haynes, 2001, Osteoprotegerin and receptor activator of nuclear factor kappaB ligand (RANKL) regulate osteoclast formation by cells in the human rheumatoid arthritic joint, Rheumatology, 40, 623, 10.1093/rheumatology/40.6.623

Crotti, 2002, Receptor activator NF-kappa B ligand (RANKL) expression in synovial tissue from patients with rheumatoid arthritis, spondyloarthropathy, osteoarthritis, and from normal patients: Semiquantitative and quantitative analysis, Ann Rheum Dis, 61, 1047, 10.1136/ard.61.12.1047

Gravallese, 2000, Synovial tissue in rheumatoid arthritis is a source of osteoclast differentiation factor, Arthritis Rheum, 43, 250, 10.1002/1529-0131(200002)43:2<250::AID-ANR3>3.0.CO;2-P

Ritchlin, 2003, Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis, J Clin Invest, 111, 821, 10.1172/JCI200316069

Sparks, 2001, Mutation screening of the TNFRSF11A gene encoding receptor activator of NF kappa B (RANK) in familial and sporadic Paget's disease of bone and osteosarcoma, Calcif Tissue Int, 68, 151, 10.1007/s002230001211

Hughes, 2000, Mutations in TNFRSF11A, affecting the signal peptide of RANK, cause familial expansile osteolysis, Nat Genet, 24, 45, 10.1038/71667

Whyte, 2002, Osteoprotegerin deficiency and juvenile Paget's disease, N Engl J Med, 347, 175, 10.1056/NEJMoa013096

Atkins, 2001, Osteoprotegerin inhibits osteoclast formation and bone resorbing activity in giant cell tumors of bone, Bone, 28, 370, 10.1016/S8756-3282(01)00404-5

Haynes, 2001, The osteoclastogenic molecules RANKL and RANK are associated with periprosthetic osteolysis, J Bone Joint Surg Br, 83, 902, 10.1302/0301-620X.83B6.0830902

Ju, 1997, Comparison of analytical performance and biological variability of three bone resorption assays, Clin Chem, 43, 1570, 10.1093/clinchem/43.9.1570

Chesnut, 1997, Hormone replacement therapy in postmenopausal women: Urinary N-telopeptide of type I collagen monitors therapeutic effect and predicts response of bone mineral density, Am J Med, 102, 29, 10.1016/S0002-9343(96)00387-7

Eastell, 2000, Biological variability of serum and urinary N-telopeptides of type I collagen in postmenopausal women, J Bone Miner Res, 15, 594, 10.1359/jbmr.2000.15.3.594

Frost, 1969, Tetracycline-based histological analysis of bone remodeling, Calcif Tissue Res, 3, 211, 10.1007/BF02058664

Eriksen, 1986, Normal and pathological remodeling of human trabecular bone: Three dimensional reconstruction of the remodeling sequence in normals and in metabolic bone disease, Endocr Rev, 7, 379, 10.1210/edrv-7-4-379

Schnitzer, 2000, Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis, Aging Clin Exp Res, 12, 1, 10.1007/BF03339822

Harris, 1999, Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: A randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group, JAMA, 282, 1344, 10.1001/jama.282.14.1344

Reid, 2002, Intravenous zoledronic acid in postmenopausal women with low bone mineral density, N Engl J Med, 346, 653, 10.1056/NEJMoa011807

Johnston, 2000, Long-term effects of raloxifene on bone mineral density, bone turnover, and serum lipid levels in early postmenopausal women: Three-year data from 2 double-blind, randomized, placebo-controlled trials, Arch Intern Med, 160, 3444, 10.1001/archinte.160.22.3444

Tonino, 2000, Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. Phase III Osteoporosis Treatment Study Group, J Clin Endocrinol Metab, 85, 3109

Fogelman, 2000, Risedronate reverses bone loss in postmenopausal women with low bone mass: Results from a multinational, double-blind, placebo-controlled trial. BMD-MN Study Group, J Clin Endocrinol Metab, 85, 1895

Brown, 2002, The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis, Calcif Tissue Int, 71, 103, 10.1007/s00223-002-2011-8

Wiley, 1995, Identification and characterization of a new member of the TNF family that induces apoptosis, Immunity, 3, 673, 10.1016/1074-7613(95)90057-8

Emery, 1998, Osteoprotegerin is a receptor for the cytotoxic ligand TRAIL, J Biol Chem, 273, 14363, 10.1074/jbc.273.23.14363