A Study to Evaluate the Efficacy and Safety of HLX14 vs. Denosumab Prolia® in Postmenopausal Women With Osteoporosis at High Risk of Fracture

Postmenopausal Clinical Trial

Official title:

A Randomized, Double-Blind, International Multicentre, Parallel-Controlled Phase III Clinical Study to Evaluate Recombinant Anti-RANKL Human Monoclonal Antibody Injection (HLX14) Versus Denosumab Injection (Prolia®) in Postmenopausal Women With Osteoporosis at High Risk of Fracture

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05352516
• Other study ID #: HLX14-002-PMOP301
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: June 17, 2022
• Est. completion date: August 10, 2024

Study information

• Verified date: August 2023
• Source: Shanghai Henlius Biotech
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a randomized, double-blind, international multicentre, parallel-controlled phase III clinical study.

The study plans to enroll 478 postmenopausal women with osteoporosis at high risk of fracture, whom will be randomized at 1:1 to either the experiment group (HLX14) or the control group (Prolia®) based on stratification factors (BMI (< 25, 25-30, > 30) and geographic region (Asian or non-Asian)).

The study includes screening period (28 days), treatment period (total 546 days, contain treatment period 1: D1-D364, treatment period 2: D365-D546), and an end-of-study visit (D547).

Description:

• Screening period: From Day -28 to -1, all female with postmenopausal osteoporosis subjects at high risk of fracture sign the informed consent form (ICF) and undergo relevant tests. Those who meet the inclusion criteria and do not meet the exclusion criteria will be randomly assigned into either experiment group (HLX14) or control group (Prolia®) at 1:1 and then enter the treatment period. Vitamin D and calcium supplementation is allowed during the screening period.

• Treatment period: Subjects will receive a total of 3 doses of subcutaneous injection of HLX14 or Prolia® (once every 6 months (Q6M)).

Treatment period 1: D1-D364, subjects will receive subcutaneous injection of HLX14 or Prolia® 60mg on D1 and D183.

Treatment period 2: D365-D546, on D365, subjects in the Prolia® arm will be re-randomized 1:1 to either continue with a third dose of Prolia® or transition to HLX14 and receive a single dose of HLX14. Subjects in the HLX14 arm will be continue with a third dose of HLX14.

• During the treatment period, subjects should taking at least 1000 mg of calcium daily and at least 400 IU of vitamin D daily until the end of study. (Dose will be adjusted by the investigator based on serum calcium)

• End-of-study visit: The end-of-study visit will be conducted on D547 of the study or premature withdrawal. Only serious adverse events related to the investigational product will be recorded thereafter.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 478
• Est. completion date: August 10, 2024
• Est. primary completion date: April 30, 2024
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 60 Years to 90 Years

Eligibility

Inclusion Criteria:

1. Ambulatory postmenopausal women with osteoporosis aged 60-90 years (both inclusive);

2. Postmenopausal, defined as > 2 years of menopause, i.e., > 2 years of spontaneous amenorrhea or > 2 years after bilateral oophorectomy;

3. Bone mineral density (BMD) T-score between -2.5 and -4.0 at the lumbar spine or total hip, i.e., -4.0 < T-score = -2.5, as assessed by the central imaging vendor at the time of screening, based on dual-energy x-ray absorptiometry (DXA) scans;

4. At least 2 vertebrae in the L1-L4 region of lumbar spine and at least one hip are evaluable by DXA, assessed by the central imaging

Exclusion criteria:

1. Diseases that may affect bone metabolism;

2. Thyroid disorders;

3. With serious primary diseases in the cardiovascular, cerebrovascular, or hematopoietic system;

4. Subjects with rheumatoid arthritis or ankylosing spondylitis;

5. Malabsorption syndrome or various gastrointestinal disorders associated with malabsorption;

6. Severe renal impairment due to renal disease with a glomerular filtration rate < 30 mL/min;

7. Hepatic diseases;

8. With serious primary diseases in the cardiovascular, cerebrovascular, or hematopoietic system judged by investigator;

9. Positive for human immunodeficiency virus (HIV) antibody;

10. Vitamin D deficiency;

11. Abnormal serum calcium;

12. Oral and dental diseases;

13. Active or uncontrolled infection requiring systemic therapy within 2 weeks prior to first dose;

14. Type 1 diabetic patients, or type 2 diabetic patients who have poor blood glucose control or are treated with insulin, glucagon-like peptide-1 (GLP-1), thiazolidinediones, SGLT2 inhibitors, etc;

15. Participating in clinical trials of other medical devices or drugs or reaching less than 30 days or 5 half-lives after the last visit in the clinical trials of other medical devices or drugs (non-bone metabolism related drugs) (whichever is longer, calculated from the date of ICF signing). Bone metabolism related drugs should comply with the corresponding prohibition time limit, and anti-osteoporosis drugs should be excluded. Those who have failed in the screening period of other clinical trials but have not yet been treated with drugs/clinical devices can be included in this study;

16. Having received Denosumab and its biosimilars, or Romosozumab and its biosimilars, cathepsin K inhibitor therapy prior to randomization;

17. Having received the following osteoporosis treatments, or medications that affect bone metabolism or any herbal medications:

1) Use of bisphosphonates(oral or intravenous) ,fluoride and strontium prior to randomization.

2) Use of parathyroid hormone (PTH) or PTH analogues, such as teriparatide, within 12 months prior to randomization.

3) Use of systemic hormone replacement therapy (HRT), selective estrogen receptor modulators, tibolone, anabolic hormones, testosterone, androgens, gonadotropin releasing hormone agonists, adrenocorticotropic hormone, within 12 months prior to randomization.

4) Use of calcitonin, calcitriol, alfacalcidol and vitamin D analogues within 12 months prior to randomization: 5) Use of any of the following within 3 months prior to randomization: heparin, warfarin, anticonvulsants (except benzodiazepines), systemic use of ketoconazole, cinacalcet, aluminum, lithium, protease inhibitors, methotrexate, and oral or parenteral glucocorticoids (= 5 mg/day prednisone daily or equivalent for > 10 days).

6) Use of any herbal medications within 2 weeks (If the herbal medications contain the above components that affect bone metabolism, should follow the corresponding elution period of bone metabolism components);

18. Subjects with a history or presence of hip fracture or .prevalent vertebral (any severe or more than 2 moderate prevalent vertebral fractures);

19. Subjects in active healing fracture in the opinion of the investigator;

20. Subjects at very high risk of fracture who must be treated immediately with an active drug in the opinion of the investigator;

21. Known allergic to the drugs listed in the study protocol, including a history of allergy to denosumab, any recombinant protein drugs, or any ingredients used in HLX14 or Prolia®;

22. With a history and presence of smoking, except for the following suituation:

1. non-smokers (A history of never smoking > 5 cigarettes/day and not smoking at all for at least the last 2 years prior to screening process)

2. light smokers (with smoking habit <5 cigarettes/day, smoking period <10 years. Light smokers should have not smoked more than 1 cigarette in the week before starting the medical screening process)

23. With a history of drug or alcohol abuse, and with evidence of alcohol or drug abuse within 12 months;

24. Various physical or psychiatric disorders or laboratory abnormalities which, in the opinion of the investigator, will prevent the subject from completing the study or interfere with the interpretation of study results. Or the subjects presenting other factors not suitable for participation in the opinion of the investigator.

Related Conditions & MeSH terms

• Osteoporosis
• Postmenopausal

Intervention

Biological:
• HLX14
Subjects will receive a total of 3 doses of subcutaneous injection of HLX14 (once every 6 months (Q6M)). Treatment period 1: D1-D364, subjects will receive subcutaneous injection of HLX14 60mg on D1 and D183. Treatment period 2: D365-D546, on D365, subjects will be continue with a third dose of HLX14.
• Prolia®
Subjects will receive a total of 3 doses of subcutaneous injection of HLX14 or Prolia® (once every 6 months (Q6M)). Treatment period 1: D1-D364, subjects will receive subcutaneous injection of Prolia® 60mg on D1 and D183. Treatment period 2: D365-D546, on D365, subjects in the Prolia® arm will be re-randomized 1:1 to either continue with a third dose of Prolia® or transition to HLX14 and receive a single dose of HLX14.

Locations

Country	Name	City	State
China	Inner Mongolia Baogang hospital	Baotou	Inner Mongolia
China	Beijing BOAI Hospital	Beijing
China	Beijing Hospital	Beijing
China	Beijing Jishuitan Hospital	Beijing
China	BeiJing PINGGU Hospital	BeiJing
China	The Third Xiangya Hospital of Central South University	Changsha
China	Changzhou NO.2 People's Hospital	Changzhou
China	West China Hospital of Sichuan University	Chengdu
China	Chongqing University three Gorges Hospital	Chongqing
China	The Second Affiliated Hospital of Chongqing Medical University	Chongqing
China	Department of Geriatrics, Guangzhou First People's Hospital	Guangzhou
China	Guangzhou First People's Hospital	Guangzhou
China	The Fourth Affiliated Hospital of Harbin Medical University	Ha'erbin	Heilongjiang
China	Zhejiang Provincial People's Hospital	Hangzhou	Zhejiang
China	The First Affiliated Hospital of USTC Anhui Provincial Hospital	Hefei
China	Huai'an First People's Hospital	Huai'an	Jiangsu
China	Qilu Hospital of Shandong University	Jinan
China	Shandong Provincial Hospital	Jinan
China	Affiliated Hospital of Jining Medical University	Jining
China	The Third People's Hospital of Yunnan Province	Kunming
China	Henan Luoyang Orthopedic Hospital	Luoyang
China	The First Affiliated Hospital of Henan University of Science and Technology	Luoyang
China	Jiangxi Provincial People's Hospital	Nanchang
China	Nanchang Hongdu Hospital of traditional Chinese Medicine	Nanchang
China	Nanchang Third Hospital	Nanchang
China	The Second Affiliated Hospital of Nanjing Medical University	Nanjing	Jiangsu
China	Pingxiang Peoples's Hospital	Pingxiang
China	Ruian People's Hospital	Rui'an	Jiangxi
China	The First Hospital of Hebei Medical University	Shijiazhuang	Hebei
China	Suining Central Hospital	Suining
China	First Hospital of Shanxi Medical University	Taiyuan
China	Second hospital of Shanxi Medical University	Taiyuan
China	Tianjin First Central Hospital	Tianjin
China	Weifang People's Hospital	Weifang
China	Union Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology	Wuhan
China	Honghui Hospital,Xi'an Jiaotong University	Xi'an
China	Affiliated Hospital of Xuzhou Medical University	Xuzhou	Jiangsu
China	People's Hospital of Ningxia Hui Autonomous Region	Yinchuan	Ningxia

Sponsors (1)

Lead Sponsor	Collaborator
Shanghai Henlius Biotech

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Primary efficacy endpoint	Percent change from baseline in BMD at the lumbar spine to Week 52 (D365) (assessed by the central imaging).; Note: The percent change in BMD is calculated as: (Test value - Baseline value) / (Baseline Value) × 100%	52 Weeks
Primary	Primary pharmacodynamic endpoint	Area under the effect-time curve for percent change from baseline of serum type I collagen C-telopeptide (s-CTX) from 0 to Week 26 (D183) (AUEC0-26W)	26 Weeks
Secondary	Secondary efficacy endpoint	Percent change from baseline in BMD at the lumbar spine to Week 26 (D183), Week 52 (D365),Week78 (D547) (assessed by investigator).; Fracture rate from baseline to Week 52 (D365), Week 78 (D547).; Percent change in BMD at lumbar spine from baseline to Week 26 (D183), Week 78 (D547) (assessed by the central imaging).; Percent change in BMD at total hip from baseline to Week 26 (D183), Week 52 (D365) and Week 78 (D547) (assessed by the central imaging and investigator).; Percent change in BMD at the femoral neck from baseline to Week 26 (D183), Week 52 (D365) and Week 78 (D547) (assessed by the central imaging and investigator).; Note: Fracture rate=(number of patients with new fractures/total number of patients)*100% The percent change in BMD is calculated as (test value - baseline value) ÷ (baseline value) × 100%	78 Weeks
Secondary	Secondary pharmacodynamic endpoint	Relative percent change in serum type I collagen C-telopeptide (s-CTX) from baseline to D15, D29, D57, D92, D106, D134, D162, D183 (within 7 days prior to the second dose), D274, D365 (within 7 days prior to the third dose), and D547 (at the end-of-study visit).; Relative percent changes in serum procollagen type I N propeptide (s-P1NP) from baseline to D15, D29, D57, D92, D106, D134, D162, D183 (within 7 days prior to the second dose), D274, D365 (within 7 days prior to the third dose) and D547 (at the end-of-study visit).; The relative percent change is calculated as: (Test value at timepoints evaluated - Baseline value) / (Baseline value) × 100%	78 Weeks