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Hadji P, Kamali L, Thomasius F, Horas K, Kurth A, Bock N. Real-world efficacy of a teriparatide biosimilar (RGB-10) compared with reference teriparatide on bone mineral density, trabecular bone score, and bone parameters assessed using quantitative ultrasound, 3D-SHAPER ® and high-resolution peripheral computer tomography in postmenopausal women with osteoporosis and very high fracture risk. Osteoporos Int 2024:10.1007/s00198-024-07208-z. [PMID: 39093439 DOI: 10.1007/s00198-024-07208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
A retrospective analysis comparing a teriparatide biosimilar (RGB-10) with reference teriparatide for osteoporosis treatment in postmenopausal women at high fracture risk found them to be therapeutically equivalent. Both provided significant improvements in lumber spine BMD, TBS, and other parameters of bone health, assessed using multiple diagnostic methods. PURPOSE To compare the therapeutic efficacy of a teriparatide biosimilar (RGB-10) with reference teriparatide for the treatment of osteoporosis in postmenopausal women at very high fracture risk. METHODS A retrospective analysis of 25 postmenopausal female patients treated for osteoporosis with RGB-10 for 24 months and a matched cohort of 25 patients treated with reference teriparatide. The following outcomes were assessed at baseline, 12 and 24 months: bone mineral density (BMD) at the lumbar spine, femoral neck and total hip using dual-energy x-ray absorptiometry (DXA) and integral, trabecular and cortical volumetric and surface BMD using 3D-SHAPER® imaging, trabecular bone score (TBS), quantitative ultrasound (QUS) measurements, and high-resolution peripheral quantitative computed tomography (HRpQCT) imaging of the radius and tibia. RESULTS No significant differences were observed between treatment groups in any of the measured parameters of BMD or bone health at baseline as well as in any timepoint when assessed using these various diagnostic methods. Both compounds provided equivalent significant improvements from baseline in measures of osteoporosis and fracture risk. CONCLUSION The results of the analysis demonstrate the therapeutic equivalence of the teriparatide biosimilar (RGB-10) to reference teriparatide for the treatment of osteoporosis in postmenopausal women at very high risk of fracture.
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Affiliation(s)
- Peyman Hadji
- Frankfurt Centre for Bone Health and Endocrinology, Frankfurt, Germany.
- Philipps University of Marburg, Marburg, Germany.
| | - Luka Kamali
- Department of Anesthesiology, University of Giessen, Giessen, Germany
| | | | - Konstantin Horas
- Frankfurt Centre for Bone Health and Endocrinology, Frankfurt, Germany
- Orthopedic Center for Musculoskeletal Research, University of Wuerzburg, Wurzburg, Germany
| | - Andreas Kurth
- Privat Orthopedic Institute Dr. Baron and Colleagues, Frankfurt, Germany
- Johan Wolfgang Goethe University, Frankfurt, Germany
| | - Nina Bock
- Johan Wolfgang Goethe University, Frankfurt, Germany
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2
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Kuribayashi R, Hariu A, Nakano A, Kishioka Y. Survey of Data Package and Sample Size of Comparative Clinical Studies for Biosimilar Developments from PMDA Assessments. Pharmaceut Med 2024; 38:225-239. [PMID: 38684588 DOI: 10.1007/s40290-024-00525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The Japanese biosimilar guideline requires that the sponsors conduct clinical studies such as comparative pharmacokinetic (PK), pharmacodynamic (PD), or efficacy studies. In each biosimilar development, the sponsors consider the clinical data package, and thus clinical data packages vary among biosimilar developments. OBJECTIVES The aim of this study was to elucidate the clinical data packages for the biosimilars approved in Japan. The details of clinical data packages and sample size for the regulatory approvals of biosimilars in Japan was reported. METHODS We surveyed the clinical data packages and sample size based on the Pharmaceuticals and Medical Devices Agency (PMDA) website review reports between 2009 and 2023. RESULTS Twenty-four biosimilars have been approved based on the comparative PK and efficacy studies, 10 biosimilars have been approved based on the comparative PK/PD study, and one biosimilar has been approved based on the comparative efficacy study. Regarding the sample size, comparative PK studies were conducted in healthy volunteers or patients for up to 300 cases, although the majority enrolled only 1-100 cases (68.1%, 32/47). Comparative PD studies enrolling 1-30, 31-60, and 61-90 cases totaled 4, 7, and 4 cases, respectively. Finally, comparative efficacy studies enrolling 1-300, 301-600, and 601-900 totaled 6, 10, and 11 cases, respectively. In particular, the oncology and rheumatology areas were the first and second disease areas recruiting 601-900 patients. CONCLUSION Large numbers of patients were enrolled to conduct a comparative efficacy study. Efficient biosimilar development should be considered on the basis of the accumulation of scientific understanding of comparable features of biosimilars and their development.
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Affiliation(s)
- Ryosuke Kuribayashi
- Office of Cellular and Tissue-Based Products, Pharmaceuticals and Medical Devices Agency, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan.
- Office of Regulatory Science Research, Pharmaceuticals and Medical Devices Agency, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan.
| | - Aya Hariu
- Office of Cellular and Tissue-Based Products, Pharmaceuticals and Medical Devices Agency, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Ayuki Nakano
- Office of Cellular and Tissue-Based Products, Pharmaceuticals and Medical Devices Agency, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Yasuhiro Kishioka
- Office of Cellular and Tissue-Based Products, Pharmaceuticals and Medical Devices Agency, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
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3
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Leong CW, Yee KM, Nalaiya J, Kassim Z, Rahim SRSA, Ahmad S, Amran A, Krishnamurthy L. Pharmacokinetics and Bioequivalence of 2 Azithromycin Tablet Formulations: A Randomized, Open-Label, 2-Stage Crossover Study in Healthy Volunteers. Clin Pharmacol Drug Dev 2022; 11:1078-1083. [PMID: 35394123 DOI: 10.1002/cpdd.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/06/2022] [Indexed: 01/26/2023]
Abstract
The current study aimed to assess the bioequivalence of a new branded azithromycin with the reference formulation. An open-label, randomized, 2-stage, crossover study design was implemented involving 77 healthy volunteers under fasting conditions. Each volunteer received a single dose of 250-mg azithromycin tablets test and reference formulations separated by a 21-day washout period. Twenty-two samples were collected at pre-dose and until 72 hours post-dose. Azithromycin concentrations were analyzed using a high-performance liquid chromatography-mass spectrometry validated method following a solid-phase plasma extraction. Noncompartmental analysis was carried out to estimate the pharmacokinetic parameters, which were compared between the test and reference products using a multivariate analysis of variance. The difference between Cmax and AUC0-72 of the test and reference formulation was not significant. The 94.1% confidence intervals of ln-transformed Cmax and AUC0-72 of azithromycin were within the bioequivalence acceptance limits of 80%-125%, therefore it can be concluded that the tested formulation is bioequivalent to the reference formulation.
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Affiliation(s)
| | - Kar Ming Yee
- Duopharma Innovation Sdn. Bhd, Shah Alam, Selangor, Malaysia
| | | | - Zawahil Kassim
- Duopharma Innovation Sdn. Bhd, Shah Alam, Selangor, Malaysia
| | | | - Shahnun Ahmad
- Duopharma Innovation Sdn. Bhd, Shah Alam, Selangor, Malaysia
| | - Atiqah Amran
- Duopharma Innovation Sdn. Bhd, Shah Alam, Selangor, Malaysia
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Tian A, Jia H, Zhu S, Lu B, Li Y, Ma J, Ma X. Romosozumab versus Teriparatide for the Treatment of Postmenopausal Osteoporosis: A Systematic Review and Meta-analysis through a Grade Analysis of Evidence. Orthop Surg 2021; 13:1941-1950. [PMID: 34643048 PMCID: PMC8528978 DOI: 10.1111/os.13136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To provide a systematic review about the efficacy and safety of romosozumab and teriparatide for the treatment of postmenopausal osteoporosis. METHOD Randomized controlled trials (RCTs) were searched from electronic databases, including PubMed (1996 to June 2019), Embase (1980 to June 2019), Cochrane Library (CENTRAL, June 2019), Web of Science (1998 to June 2019), and others. The primary outcomes included the following: the percentage change in bone mineral density of lumbar spine and total hip from baseline at month 6 and month 12 in each group. The secondary outcomes included the following: the percentage change in bone mineral density of femoral neck from baseline at month 6 and month 12 in each group and the incidence of adverse events at month 12 in each group. RESULTS Four studies containing 1304 patients met our selection criteria. The result of our analysis indicated that romosozumab showed better effects in improving BMD of lumbar spine (month 6: MD = 3.54, 95% CI [3.13, 3.94], P<0.001; month 12: MD = 4.93, 95% CI [4.21, 5.64], P<0.001), total hip (month 6: MD = 2.27, 95% CI [0.62, 3.91], P = 0.007; month 12: MD = 3.17, 95% CI [2.68, 3.65], P<0.001), and femoral neck (month 6: MD = 2.30, 95% CI [0.51, 4.08], P = 0.01; month 12: MD = 3.04, 95% CI [2.29, 3.78], P<0.001). Also, the injection-site reaction was less (month 12: RR = 2.84, 95% CI [1.22, 6.59], P = 0.02), but there were no significant difference in the incidence of serious adverse events (month 12: RR = 0.78, 95% CI [0.46, 1.33], P = 0.37) and death (month 12: RR = 0.61, 95% CI [0.08, 4.62], P = 0.63). CONCLUSION Based on the available studies, our current results demonstrate that romosozumab was better than teriparatide both in terms of efficacy and side effects.
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Affiliation(s)
- Aixian Tian
- Orthopedic Research Institute, Tianjin Hospital Heping BranchTianjin UniversityTianjinChina
| | - Haobo Jia
- Tianjin Medical UniversityTianjinChina
- Orthopaedics Institute, Tianjin HospitalTianjin UniversityTianjinChina
| | - Shan Zhu
- Department of Radiology, Tianjin HospitalTianjin UniversityTianjinChina
| | - Bin Lu
- Orthopedic Research Institute, Tianjin Hospital Heping BranchTianjin UniversityTianjinChina
| | - Yan Li
- Orthopedic Research Institute, Tianjin Hospital Heping BranchTianjin UniversityTianjinChina
| | - Jianxiong Ma
- Orthopedic Research Institute, Tianjin Hospital Heping BranchTianjin UniversityTianjinChina
| | - Xinlong Ma
- Orthopedic Research Institute, Tianjin Hospital Heping BranchTianjin UniversityTianjinChina
- Orthopaedics Institute, Tianjin HospitalTianjin UniversityTianjinChina
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5
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Raykova E, Farmahini Farahani M, Ivanova S, Azhdarzadeh M. A randomized pharmacokinetic/pharmacodynamic study comparing the bioequivalence of potential biosimilar candidate P044 with reference medicine in healthy volunteers. Expert Opin Biol Ther 2021; 22:235-243. [PMID: 34405742 DOI: 10.1080/14712598.2021.1970742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND P044 is a proposed biosimilar candidate of Teriparatide for reference medicine, Forsteo®. This study was designed to evaluate the Pharmacokinetic/Pharmacodynamic (PK/PD) bioequivalence between P044 and Forsteo®. METHODS In this randomized, open-label, single-dose, crossover study, 66 healthy female subjects were randomized to receive P044 and Forsteo®. The primary PK endpoints of the study were the area under the concentration versus time from zero to infinity (AUC0-inf) and maximum plasma concentration (Cmax). Secondary endpoints included area under the concentration versus time from zero to the last quantifiable concentration (AUC0-last) and Cmax for PD parameter, additional PK parameters and safety. RESULTS Sixty-six subjects were enrolled in the study and baseline demographics were similar between the two treatments. The two treatments presented similar PK/PD parameters and the 90% confidence interval for primary and secondary endpoints were within the bioequivalence acceptance range (80.00-125.00%) for all parameters. None of the subjects experienced serious adverse event, and all of the reported adverse events were mild and similar between two treatments. CONCLUSIONS This study demonstrated the PK/PD similarity of P044 to reference medicine, Forsteo® and safety profiles were comparable between treatments. TRIAL REGISTRATION EudraCT Number: 2019-004477-82.
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Affiliation(s)
| | - Mohammad Farmahini Farahani
- CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj, Iran.,CinnaGen Research and Production co., Alborz, Iran
| | | | - Morteza Azhdarzadeh
- CinnaGen Medical Biotechnology Research Center, Alborz University of Medical Sciences, Karaj, Iran.,CinnaGen Research and Production co., Alborz, Iran.,Department of Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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6
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Review of Current Real-World Experience with Teriparatide as Treatment of Osteoporosis in Different Patient Groups. J Clin Med 2021; 10:jcm10071403. [PMID: 33915736 PMCID: PMC8037129 DOI: 10.3390/jcm10071403] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 12/17/2022] Open
Abstract
Teriparatide has proven effective in reducing both vertebral and non-vertebral fractures in clinical trials of post-menopausal and glucocorticoid-induced osteoporosis. Widespread adoption of Teriparatide over the last two decades means that there is now substantial experience of its use in routine clinical practice, which is summarized in this paper. Extensive real-world experience of Teriparatide in post-menopausal osteoporosis confirms the fracture and bone density benefits seen in clinical trials, with similar outcomes identified also in male and glucocorticoid-induced osteoporosis. Conversely, very limited experience has been reported in pre-menopausal osteoporosis or in the use of Teriparatide in combination with other therapies. Surveillance studies have identified no safety signals relating to the possible association of Teriparatide with osteosarcoma. We also review the evidence for predicting response to Teriparatide in order to inform the debate on where best to use Teriparatide in an increasingly crowded therapeutic landscape.
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7
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Belay SY, Mu R, Xu J. A Bayesian adaptive design for biosimilar trials with time-to-event endpoint. Pharm Stat 2021; 20:597-609. [PMID: 33474838 DOI: 10.1002/pst.2096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 01/01/2023]
Abstract
A biosimilar drug is a biological product that is highly similar to and at the same time has no clinically meaningful difference from licensed product in terms of safety, purity, and potency. Biosimilar study design is essential to demonstrate the equivalence between biosimilar drug and reference product. However, existing designs and assessment methods are primarily based on binary and continuous endpoints. We propose a Bayesian adaptive design for biosimilarity trials with time-to-event endpoint. The features of the proposed design are twofold. First, we employ the calibrated power prior to precisely borrow relevant information from historical data for the reference drug. Second, we propose a two-stage procedure using the Bayesian biosimilarity index (BBI) to allow early stop and improve the efficiency. Extensive simulations are conducted to demonstrate the operating characteristics of the proposed method in contrast with some naive method. Sensitivity analysis and extension with respect to the assumptions are presented.
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Affiliation(s)
- Sheferaw Y Belay
- School of Statistics, East China Normal University, Shanghai, China
| | - Rongji Mu
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science - MOE, East China Normal University, Shanghai, China.,School of Statistics, East China Normal University, Shanghai, China
| | - Jin Xu
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science - MOE, East China Normal University, Shanghai, China.,School of Statistics, East China Normal University, Shanghai, China
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8
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Kovács P, Schäfer T, Háda V, Hevér H, Klingelhöfer S, Nebel M, Stadie T, Kiss R, Urbányi Z. Comparative Physicochemical and Biological Characterisation of the Similar Biological Medicinal Product Teriparatide and Its Reference Medicinal Product. BioDrugs 2020; 34:65-75. [PMID: 31595483 PMCID: PMC6985066 DOI: 10.1007/s40259-019-00386-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background In January 2017, the European Commission approved Terrosa® (company code RGB-10) as one of the first biosimilar medicinal products of teriparatide for the same indications as for the reference medicinal product Forsteo® (Lilly France S.A.S.), which has been on the market in the European Union since 2003. The active pharmaceutical ingredient of the reference medicinal product is the biologically active 1-34 fragment of the endogenous human parathyroid hormone [PTH(1-34)]. It is one of the three bone anabolic agents used in the treatment of osteoporosis promoting bone formation and preventing fragility fractures. Objective The objective of this paper is to summarise the results of the comparative analysis of representative batches of both the RGB-10 drug product and the reference medicinal product performed by physicochemical and in vitro biological methods. Methods A series of state-of-the-art analytical methods were applied in a comparative head-to-head manner for testing the similarity in respect to purity, content, structure and potency. Results Based on the results of the comprehensive physicochemical and biological characterisation, RGB-10 proved to be highly similar to the reference medicinal product with respect to the critical quality attributes investigated. Conclusion The results of the quality comparability study demonstrated similarity of RGB-10 to the reference medicinal product, providing the scientific basis for conducting a specifically designed clinical programme, and supported registration of the Marketing Authorisation Application of RGB-10 in the EU.
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Affiliation(s)
- Piroska Kovács
- Chemical Works of Gedeon Richter Plc, Gyömrői út 19-21, Budapest, 1103, Hungary
| | - Tamás Schäfer
- Chemical Works of Gedeon Richter Plc, Gyömrői út 19-21, Budapest, 1103, Hungary
| | - Viktor Háda
- Chemical Works of Gedeon Richter Plc, Gyömrői út 19-21, Budapest, 1103, Hungary
| | - Helga Hevér
- Chemical Works of Gedeon Richter Plc, Gyömrői út 19-21, Budapest, 1103, Hungary
| | - Sonja Klingelhöfer
- Richter Helm Biologics GmbH & Co. KG, Suhrenkamp 59, 22335, Hamburg, Germany
| | - Merle Nebel
- Richter Helm Biologics GmbH & Co. KG, Suhrenkamp 59, 22335, Hamburg, Germany
| | - Tanja Stadie
- Richter Helm Biologics GmbH & Co. KG, Suhrenkamp 59, 22335, Hamburg, Germany
| | - Róbert Kiss
- Chemical Works of Gedeon Richter Plc, Gyömrői út 19-21, Budapest, 1103, Hungary
| | - Zoltán Urbányi
- Chemical Works of Gedeon Richter Plc, Gyömrői út 19-21, Budapest, 1103, Hungary.
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Minisola S, Cipriani C, Grotta GD, Colangelo L, Occhiuto M, Biondi P, Sonato C, Vigna E, Cilli M, Pepe J. Update on the safety and efficacy of teriparatide in the treatment of osteoporosis. Ther Adv Musculoskelet Dis 2019; 11:1759720X19877994. [PMID: 31632472 PMCID: PMC6778993 DOI: 10.1177/1759720x19877994] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Following the completion of the Fracture Prevention Trial, teriparatide was approved by the United States Food and Drug Administration and the European Medicine Agency as the first therapeutic anabolic agent for the treatment of postmenopausal women with severe osteoporosis. It subsequently received additional approval for the treatment of osteoporosis in men, and for the treatment of osteoporosis associated with glucocorticoid therapy in men and women at risk of fracture. In this review, we summarize the most important data concerning PTH 1-34 therapy before 2016 in the treatment of osteoporosis, and report some outstanding results published in the last 2 years. New data on safety will also discussed, together with the state of art of nonclassical utilization. Finally, in view of the recent approval of biosimilars, possible future landscapes are discussed.
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Affiliation(s)
- Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Viale del Policlinico, 155, Rome, 00161, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Giada Della Grotta
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Luciano Colangelo
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Marco Occhiuto
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Piergianni Biondi
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Chiara Sonato
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Evelina Vigna
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Mirella Cilli
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
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10
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Hagino H, Narita R, Yokoyama Y, Watanabe M, Tomomitsu M. A multicenter, randomized, rater-blinded, parallel-group, phase 3 study to compare the efficacy, safety, and immunogenicity of biosimilar RGB-10 and reference once-daily teriparatide in patients with osteoporosis. Osteoporos Int 2019; 30:2027-2037. [PMID: 31243480 PMCID: PMC6795613 DOI: 10.1007/s00198-019-05038-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/28/2019] [Indexed: 01/16/2023]
Abstract
UNLABELLED The efficacy and safety of RGB-10 and reference teriparatide were evaluated in a randomized 52-week study in 250 patients with osteoporosis at high risk of fracture. RGB-10 was equivalent to reference teriparatide in efficacy and had a comparable safety profile. INTRODUCTION RGB-10 is the first biosimilar teriparatide authorized in the European Union. This multicenter, randomized, rater-blinded, parallel-group phase 3 study evaluated equivalence in efficacy and compared safety between RGB-10 and reference teriparatide in patients with osteoporosis at high risk of fracture for registration in Japan. METHODS Ambulatory postmenopausal women and men (≥ 55 years of age) with osteoporosis at high risk of fracture were randomized 1:1 to receive either RGB-10 or reference teriparatide 20 μg once daily via subcutaneous self-injection for 52 weeks. The primary efficacy endpoint was the percent change from baseline to 52 weeks in lumbar spine (L2-L4) bone mineral density (BMD). Safety outcomes and immunogenicity were also assessed. RESULTS In total, 250 patients (125 in each group) were randomized. The percent change from baseline to 52 weeks in lumbar spine (L2-L4) BMD (mean ± standard deviation) was 8.94% ± 6.19% in the RGB-10 group and 9.65% ± 6.22% in the reference teriparatide group. The estimated between-group difference (95% confidence interval) was - 0.65% (- 2.17% to - 0.87%) within the pre-specified equivalence margin (± 2.8%), which indicates equivalence in efficacy between the two groups. Changes in BMD at lumbar spine (L1-L4), femoral neck, and total hip and serum procollagen type I amino-terminal propeptide were also similar between the groups. Safety profiles, including immunogenicity, were comparable. CONCLUSIONS The therapeutic equivalence of RGB-10 to reference teriparatide was demonstrated. RGB-10 had comparable safety profile to that of reference teriparatide.
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Affiliation(s)
- H Hagino
- School of Health Science, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago City, Tottori, 683-8503, Japan.
| | - R Narita
- Mochida Pharmaceutical Co. Ltd, Tokyo, Japan
| | - Y Yokoyama
- Mochida Pharmaceutical Co. Ltd, Tokyo, Japan
| | - M Watanabe
- Mochida Pharmaceutical Co. Ltd, Tokyo, Japan
| | - M Tomomitsu
- Mochida Pharmaceutical Co. Ltd, Tokyo, Japan
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11
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Nasal Administration and Plasma Pharmacokinetics of Parathyroid Hormone Peptide PTH 1-34 for the Treatment of Osteoporosis. Pharmaceutics 2019; 11:pharmaceutics11060265. [PMID: 31181662 PMCID: PMC6631119 DOI: 10.3390/pharmaceutics11060265] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022] Open
Abstract
Nasal delivery of large peptides such as parathyroid 1-34 (PTH 1-34) can benefit from a permeation enhancer to promote absorption across the nasal mucosa into the bloodstream. Previously, we have published an encouraging bioavailability (78%), relative to subcutaneous injection in a small animal preclinical model, for a liquid nasal spray formulation containing the permeation enhancer polyethylene glycol (15)-hydroxystearate (Solutol® HS15). We report here the plasma pharmacokinetics of PTH 1-34 in healthy human volunteers receiving the liquid nasal spray formulation containing Solutol® HS15. For comparison, data for a commercially manufactured teriparatide formulation delivered via subcutaneous injection pen are also presented. Tc-99m-DTPA gamma scintigraphy monitored the deposition of the nasal spray in the nasal cavity and clearance via the inferior meatus and nasopharynx. The 50% clearance time was 17.8 min (minimum 10.9, maximum 74.3 min). For PTH 1-34, mean plasma Cmax of 5 pg/mL and 253 pg/mL were obtained for the nasal spray and subcutaneous injection respectively; relative bioavailability of the nasal spray was ≤1%. Subsequently, we investigated the pharmacokinetics of the liquid nasal spray formulation as well as a dry powder nasal formulation also containing Solutol® HS15 in a crossover study in an established ovine model. In this preclinical model, the relative bioavailability of liquid and powder nasal formulations was 1.4% and 1.0% respectively. The absolute bioavailability of subcutaneously administered PTH 1-34 (mean 77%, range 55-108%) in sheep was in agreement with published human data for teriparatide (up to 95%). These findings have important implications in the search for alternative routes of administration of peptides for the treatment of osteoporosis, and in terms of improving translation from animal models to humans.
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