FDA approves new indication for Prolia® (Denosumab) for the treatment of bone loss in men with osteoporosis at high risk for fracture
Publication date: 20 September 2012
Amgen (NASDAQ:AMGN) today announced the U.S. Food and Drug Administration (FDA) approved a new indication for Prolia® (denosumab) as a treatment to increase bone mass in men with osteoporosis at high risk for fracture. Prolia, the first FDA-approved RANK Ligand inhibitor, is a subcutaneous injection administered by a health care professional every six months.
"While osteoporosis and osteoporosis-related fractures are more commonly associated with postmenopausal women, osteoporosis in men is a significant issue that is increasing in prevalence as life expectancies rise," said Sean E. Harper, M.D., executive vice president of Research and Development at Amgen. "Fractures can be a life-changing event, so we are pleased that we can offer a new treatment option for the growing number of men with osteoporosis at high risk for fracture."
According to the National Osteoporosis Foundation, two million men in the U.S. have osteoporosis and another 12 million are at risk.1 Osteoporosis and osteoporotic fractures in men remain under diagnosed and under treated.2
The new indication for Prolia is based on results from the ADAMO trial3 (A multicenter, randomized, double-blind, placebo-controlled study to compare the efficacy and safety of DenosumAb 60 mg every six months versus placebo in Males with Osteoporosis), the pivotal Phase 3 study involving 242 men with low bone mineral density (BMD). In the study, treatment with Prolia resulted in significantly greater gains at the lumbar spine when compared to placebo (5.7 percent vs. 0.9 percent). Effects of Prolia on BMD were independent of age, baseline testosterone levels, BMD status and estimated fracture risk.
Additional results showed that patients in the study who received treatment with Prolia experienced BMD increases at all other skeletal sites assessed compared to placebo, including at the total hip (2.4 percent vs. 0.3 percent) and at the femoral neck (2.1 percent vs. 0.0 percent). Safety findings were consistent with what have been observed in other studies of Prolia in postmenopausal women with osteoporosis. The most common adverse reactions reported (per patient incidence > 5 percent) were back pain, arthralgia and nasopharyngitis.
Prolia Clinical Data
Approval was based on the ADAMO trial 12-month data. Men between the ages of 30 and 85 years with low BMD (T-score ≤–2.0 and ≥–3.5 at the lumbar spine or femoral neck) or who have experienced a prior major osteoporotic fracture and had a T-score ≤–1.0 and ≥–3.5 were enrolled in the study. Patients were randomized (1:1) to receive either 60 mg of Prolia every six months or placebo. All patients received daily calcium and vitamin D supplementation throughout the study. 3
The primary study endpoint was the percent change from baseline in the lumbar spine BMD at month 12. Secondary efficacy endpoints included percent change in total hip and femoral neck BMD from baseline to one year.
About Male Osteoporosis
Osteoporosis in men has recently been recognized as an important public health issue, as male life expectancies rise and the number of men over the age of 70 grows. 4 Between 2010 and 2020, the number of men with osteoporosis is expected to increase by 17 percent.1 Approximately one in four men in the U.S. over the age of 50 will have an osteoporosis-related fracture in his remaining lifetime. 5
Prolia is the first approved therapy that specifically targets RANK Ligand, an essential regulator of osteoclasts (the cells that break down bone).
Prolia is approved in the U.S. for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy. Prolia is also approved for treatment to increase bone mass in men with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy.
Prolia is administered as a single subcutaneous injection of 60 mg once every six months. For further information about Prolia, including prescribing information and medication guide, please visit http://www.prolia.com.
Important U.S. Safety Information
Prolia is contraindicated in patients with hypocalcemia. Pre-existing hypocalcemia must be corrected prior to initiating Prolia. Prolia is contraindicated in women who are pregnant and may cause fetal harm. Patients receiving Prolia should not receive XGEVA® (denosumab), as both Prolia and XGEVA contain the same active ingredient, denosumab.
Hypocalcemia may worsen with the use of Prolia, especially in patients with severe renal impairment. All patients should be adequately supplemented with calcium and vitamin D. In the Phase 3 pivotal study of women with postmenopausal osteoporosis (n=7,808), serious infections leading to hospitalizations were reported more frequently in the Prolia-treated patient group. Serious skin infections, as well as infections of the abdomen, urinary tract and ear, were more frequent in patients treated with Prolia. Patients should be advised to seek prompt medical attention if they develop signs or symptoms of severe infection, including cellulitis. Endocarditis was reported more frequently in the Prolia-treated patient group. Epidermal and dermal adverse events such as dermatitis, rashes and eczema have been reported. Discontinuation of Prolia should be considered if severe symptoms develop.
In clinical trials in women with postmenopausal osteoporosis, Prolia resulted in significant suppression of bone remodeling. The significance of these findings is unknown. The long-term consequences of the degree of suppression of bone remodeling observed with Prolia may contribute to adverse outcomes such as osteonecrosis of the jaw (ONJ), atypical fractures and delayed fracture healing. ONJ and atypical fractures have been reported in patients with Prolia. Patients should be monitored for these adverse outcomes. The most common adverse reactions (> 5 percent and more common than placebo) in patients with postmenopausal osteoporosis were back pain, pain in extremity, musculoskeletal pain, hypercholesterolemia and cystitis. The most common adverse reactions in men with osteoporosis were back pain, arthralgia and nasopharyngitis. Pancreatitis has also been reported with Prolia.
The extent to which Prolia is present in seminal fluid is unknown. For men treated with Prolia, there is a potential for fetal exposure if the sexual partner is pregnant. While the risk is likely to be low, patients should be advised of this potential risk.
National Osteoporosis Foundation. What men need to know. http://www.nof.org/aboutosteoporosis/formen/whatmenneedtoknow. Accessed April 24, 2012.
Bone Health and Osteoporosis, A Report of the Surgeon General, Department of Health and Human Services, 2004, p. 255.
Orwoll E et al. J Clin Endocrinol Metab. 2012; 97: 0000–0000.
NIH Osteoporosis and Related Bone Diseases National Resource Center, Osteoporosis in Men. Available at: http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/men.asp. Accessed September 12, 2012.
National Osteoporosis Foundation. Prevalence Report. http://www.nof.org/print/219. Accessed August 24, 2012.