One Year of Romosozumab Followed by Two Years of Denosumab Maintains Fracture Risk Reductions: Results of the FRAME Extension Study.

Abstract

Romosozumab, a humanized monoclonal antibody that binds and inhibits sclerostin, has the dual effect of increasing bone formation and decreasing bone resorption. As previously reported in the pivotal FRActure study in postmenopausal woMen with ostEoporosis (FRAME), women with a T-score of ≤ -2.5 at the total hip or femoral neck received subcutaneous placebo or romosozumab once monthly for 12 months, followed by open-label subcutaneous denosumab every 6 months for an additional 12 months. Upon completion of the 24-month primary analysis period, eligible women entered the extension phase and received denosumab for an additional 12 months. Here, we report the final analysis results through 36 months, including efficacy assessments of new vertebral, clinical, and nonvertebral fracture; bone mineral density (BMD); and safety assessments. Of 7180 women enrolled, 5743 (80%) completed the 36-month study (2851 romosozumab-to-denosumab; 2892 placebo-to-denosumab). Through 36 months, fracture risk was reduced in subjects receiving romosozumab versus placebo for 12 months followed by 24 months of denosumab for both groups: new vertebral fracture (relative risk reduction [RRR], 66%; incidence, 1.0% versus 2.8%; p < 0.001), clinical fracture (RRR, 27%; incidence, 4.0% versus 5.5%; p = 0.004), and nonvertebral fracture (RRR, 21%; incidence, 3.9% versus 4.9%; p = 0.039). BMD continued to increase for the 2 years with denosumab treatment in both arms. The substantial difference in BMD achieved through 12 months of romosozumab treatment versus placebo was maintained through the follow-up period when both treatment arms received denosumab. Subject incidence of adverse events, including positively adjudicated serious cardiovascular adverse events, were overall balanced between groups. In conclusion, in postmenopausal women with osteoporosis, 12 months of romosozumab led to persistent fracture reduction benefit and ongoing BMD gains when followed by 24 months of denosumab. The sequence of romosozumab followed by denosumab may be a promising regimen for the treatment of osteoporosis. © 2018 American Society for Bone and Mineral Research.

• Authors: E Michael Lewiecki, Rajani V Dinavahi, Marise Lazaretti-Castro, Peter R Ebeling, Jonathan D Adachi, Akimitsu Miyauchi, Evelien Gielen, Cassandra E Milmont, Cesar Libanati, Andreas Grauer
• Journal: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research (J Bone Miner Res) Vol. 34 Issue 3 Pg. 419-428 (03 2019) ISSN: 1523-4681 [Electronic] United States
• PMID: 30508316 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 American Society for Bone and Mineral Research.

Chemical References

• Antibodies, Monoclonal
• Biomarkers
• romosozumab
• Denosumab

Topics

• Aged
• Antibodies, Monoclonal (adverse effects, pharmacology, therapeutic use)
• Biomarkers (metabolism)
• Bone Density (drug effects)
• Bone Remodeling (drug effects)
• Denosumab (adverse effects, pharmacology, therapeutic use)
• Drug Administration Schedule
• Drug Therapy, Combination
• Fracture Fixation
• Fractures, Bone (drug therapy, epidemiology)
• Humans
• Incidence
• Risk Reduction Behavior