Denosumab Treatment for 5 Years of Postmenopausal Women With Osteoporosis: Results From the First Two Years of the FREEDOM Trial Extension Henry G Bone 1 , Roland Chapurlat 2 , Maria Luisa Brandi 3 , Jacques P Brown 4 , Edward Czerwinski 5 , Nadia S Daizadeh 6 , Andreas Grauer 6 , Mark-Antoine Krieg 7 , Cesar Libanati 6 , Zulema Man 8 , Dan Mellstrom 9 , Sebastiao Radominski 10 , Jean-Yves Reginster 11 , Heinrich Resch 12 , Jose Andres Román 13 , Christian Roux 14 , Steven R Cummings 15 , Socrates Papapoulos 16 1 Michigan Bone and Mineral Clinic, Detroit, MI, USA ; 2 Hôpital Edouard Herriot, Lyon, France; 3 University of Florence, Florence, Italy; 4 CHUQ Research Centre, Laval University, Quebec City, QC, Canada; 5 Krakow Medical Center, Krakow, Poland; 6 Amgen Inc., Thousand Oaks, CA, USA; 7 University Hospital of Lausanne, Lausanne, Switzerland; 8 Centro TIEMPO, Buenos Aires, Argentina; 9 Sahlgrenska University Hospital, Göteburg, Sweden; 10 Universidade Federal do Paraná, Curitiba, Brazil; 11 University of Liège, Liège, Belgium; 12 St. Vincent's Hospital, Vienna, Austria; 13 Hospital Universitario La Fe, Valencia, Spain; 14 Paris Descartes University, Paris, France; 15 San Francisco Coordinating Center, CPMC Research Institute, San Francisco, CA, USA; 16 Leiden University Medical Center, Leiden, The Netherlands AACE; San Diego, CA; April 13-17, 2011
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Denosumab Treatment for 5 Years of Postmenopausal Women With Osteoporosis:
Results From the First Two Years of the FREEDOM Trial Extension
Henry G Bone1, Roland Chapurlat2, Maria Luisa Brandi3, Jacques P Brown4, Edward Czerwinski5, Nadia S Daizadeh6, Andreas Grauer6,
Mark-Antoine Krieg7, Cesar Libanati6, Zulema Man8, Dan Mellstrom9, Sebastiao Radominski10, Jean-Yves Reginster11, Heinrich Resch12,
Jose Andres Román13, Christian Roux14, Steven R Cummings15, Socrates Papapoulos16
1Michigan Bone and Mineral Clinic, Detroit, MI, USA ; 2Hôpital Edouard Herriot, Lyon, France; 3University of Florence, Florence, Italy; 4CHUQ Research Centre, Laval University, Quebec City, QC, Canada; 5Krakow Medical Center, Krakow, Poland; 6Amgen
Inc., Thousand Oaks, CA, USA; 7University Hospital of Lausanne, Lausanne, Switzerland; 8Centro TIEMPO, Buenos Aires, Argentina; 9Sahlgrenska University Hospital, Göteburg, Sweden; 10Universidade Federal do Paraná, Curitiba, Brazil; 11University
of Liège, Liège, Belgium; 12St. Vincent's Hospital, Vienna, Austria; 13Hospital Universitario La Fe, Valencia, Spain; 14Paris Descartes University, Paris, France; 15San Francisco Coordinating Center, CPMC Research Institute, San Francisco, CA, USA;
16Leiden University Medical Center, Leiden, The Netherlands
AACE; San Diego, CA; April 13-17, 2011
Disclosures• HG Bone: Research grants and/or consulting or speaking fees from Amgen, Eli Lilly, Merck, Nordic Bioscience,
Novartis, Takeda, Tarsa, and Zelos
• R Chapurlat: Research grants and/or consulting fees from Amgen, Merck, Novartis, Roche, sanofi-aventis, Servier, and Warner Chilcott
• ML Brandi: Research grants and/or consulting fees from Amgen, Eli Lily, GSK, MSD, NPS, Nycomed, Roche, Servier, and Stroder
• JP Brown: Research grants and/or consulting or speaking fees from Abbott, Amgen, Bristol-Myers Squibb, Eli Lilly, Novartis, Merck, Pfizer, Roche, and Warner Chilcott
• E Czerwinski: Research grants from Amgen, AstraZeneca, Danone Research, Eli Lilly, Merck Sharp & Dohme, Merck Serono, Novartis, Pfizer, Roche, SantoSolve AS, and Servier
• NS Daizadeh, A Grauer, C Libanati: Employed by Amgen and own Amgen stocks or stock options
• M-A Krieg, D Mellstrom, H Resch: None
• Z Man: Lecture fees and/or consulting fees from Merck, Novartis, Roche, and sanofi-aventis; Novartis steering committee member
• S Radominski: Research grants from Amgen, Aventis, Bristol-Myers Squibb, Novartis, Pfizer, and Roche
• C Roux: Research grants and/or consulting fees from Amgen, MSD, Novartis, Roche, and Servier
• SR Cummings: Research grants and/or consulting fees from Amgen, Eli Lilly, Merck, and Novartis
• S Papapoulos: Consulting fees from Amgen, GSK, Merck, Novartis, Procter & Gamble, and Wyeth
• FREEDOM (Fracture REduction Evaluation of Denosumab in Osteoporosis Every 6 Months) assessed the efficacy and safety of 3 years of denosumab treatment compared with placebo in postmenopausal women with osteoporosis.1
• FREEDOM was extended to evaluate the safety and efficacy of long-term denosumab treatment (up to 10 years of continuous exposure).
• The first 2 years of the FREEDOM open-label extension are reported in this analysis (up to of 5 years of continuous denosumab exposure).
1Cummings SR et al., NEJM 2009;361:756-65
Background
• Describe the effects of up to 5 years of continuous denosumab exposure on:
– Changes in bone turnover and bone density
– Safety and tolerability
– Incidence of new vertebral and nonvertebral fractures
Study Objectives
International, multicenter, open-label, single-arm study
Key Inclusion Criteria:• Must have completed the FREEDOM study (received denosumab or placebo)• Not receiving any other osteoporosis medications
FREEDOM EXTENSION
1 2 3Year 0 5 6 74 8 9 10
1 2 30 5 6 74Year
RANDOMIZATION
Denosumab 60 mgSC Q6M
(N = 3902)
Denosumab 60 mgSC Q6M
(N = 2343)
PlaceboSC Q6M
(N = 3906)
Denosumab 60 mgSC Q6M
(N = 2207)
Calcium and Vitamin D
FREEDOM Extension Study Design
Long-termDenosumab
Cross-overDenosumab
Long-term DMAb Treatment EXTENSION Subjects
N = 2343
Cross-over DMAb Treatment EXTENSION
SubjectsN = 2207
FREEDOM Baseline
EXTENSION Baseline
FREEDOM Baseline
EXTENSION Baseline
Age (years) 71.9 74.9 71.8 74.8Age groups (%)
≥ 65 years 94.3% 97.9% 93.7% 97.4%≥ 75 years 28.3% 53.7% 28.3% 52.2%
LS BMD T-score –2.83 –2.14 –2.84 –2.81TH BMD T-score –1.85 –1.50 –1.85 –1.93CTX* (ng/mL) 0.524 0.183 0.554 0.568P1NP* (µg/L) 46.72 17.49 54.24 48.80N = number of subjects enrolled in the EXTENSION. Data are mean unless otherwise noted.*Includes data from 65 subjects (long-term) and 36 subjects (cross-over); values are medians.
Baseline Characteristics
Percent Change in Serum CTX and P1NP
Median (IQR)
60
40
20
0
-20
-40
-60
-80
-100
80
Perc
ent C
hang
e Fr
om B
asel
ine
1 2 3 4 50
Year
FREEDOM EXTENSION60
40
20
0
-20
-40
-60
-80
-100
80
Perc
ent C
hang
e Fr
om B
asel
ine
1 2 3 4 50
Year
FREEDOM EXTENSION
sCTX P1NP
Placebo Denosumab
Percent Change in Lumbar Spine and Total Hip BMD
LS Mean (95% CI)*p < 0.05 vs FREEDOM baseline; ^p < 0.05 vs FREEDOM and EXTENSION baseline; †p < 0.05 vs year 4.
Placebo Denosumab
* * **
^
^
FREEDOM EXTENSION10
8
6
4
2
0
-20 0.5 1 2 3 4 5
*
^
^
FREEDOM EXTENSION16
14
12
10
8
6
4
2
0
-20 0.5 1 2 3 4 5
Perc
ent C
hang
e Fr
om B
asel
ine
Perc
ent C
hang
e Fr
om B
asel
ine
Lumbar Spine Total Hip
Year Year
^†
^†
^†
^†
Exposure-adjusted Subject Incidence of Adverse Events (Rates per 100 Patient-years)
n = number of subjects with ≥ 1 fractureN = number of randomized subjects who remained on study at the beginning of each period *Annualized rate
2.6%
2.1% 2.2%
3.1%2.9%
2.5%
4 5
EXTENSION
23433454 34873688 36823906 3902 2242
1.4%1.1%
3283 73103 75116 98 25
Yearly Incidence of Nonvertebral Fractures: Long-term Denosumab Group
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%FREEDOM
Nn
Placebo Denosumab
n = number of subjects with ≥ 1 fractureN = number of randomized subjects who remained on study at the beginning of each period
1 2 3Years of Treatment Exposure
Yearly Incidence of New Vertebral Fractures: Cross-over Denosumab Group
Placebo Denosumab Denosumab Cross-over
n = number of subjects with ≥ 1 fractureN = number of randomized subjects who remained on study at the beginning of each period
2.5%
0.9%0.7%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
1 and 2* 1 and 2*19783691 370234183 53
EXTENSIONFREEDOM
Nn
Years of Treatment Exposure
*Annualized rate
Yearly Incidence of Nonvertebral Fractures: Cross-over Denosumab Group
3.1%
2.4%2.6%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
1 122073906N 390252116 98n
2.9%
1.7%
2.1%
23688 3682103 75
210435
2
n = number of subjects with ≥ 1 fractureN = number of randomized subjects who remained on study at the beginning of each period
Placebo Denosumab Denosumab Cross-over
EXTENSIONFREEDOM EXTENSIONFREEDOM
Years of Treatment Exposure
Summary
• Denosumab treatment for 5 years (long-term group):
− Maintained the reduction in bone turnover
− Significantly increased BMD year over year
− Remained well tolerated with an AE profile similar in years 4 and 5 to that observed in the 3 years of the placebo-controlled FREEDOM study
− Maintained a low incidence of new vertebral and nonvertebral fractures
• Denosumab treatment for 2 years (cross-over group) largely reproduced the original findings from FREEDOM
Denosumab Treatment for 5 Years of Postmenopausal Women With Osteoporosis:
Results From the First Two Years of the FREEDOM Trial Extension
Henry G Bone1, Roland Chapurlat2, Maria Luisa Brandi3, Jacques P Brown4, Edward Czerwinski5, Nadia S Daizadeh6, Andreas Grauer6, Mark-Antoine Krieg7, Cesar Libanati6, Zulema Man8, Dan Mellstrom9, Sebastiao
Radominski10, Jean-Yves Reginster11, Heinrich Resch12, Jose Andres Román13, Christian Roux14, Steven R Cummings15, Socrates Papapoulos16
1Michigan Bone and Mineral Clinic, Detroit, MI, USA ; 2Hôpital Edouard Herriot, Lyon, France; 3University of Florence, Florence, Italy; 4CHUQ Research Centre, Laval University, Quebec City, QC, Canada; 5Krakow Medical Center, Krakow, Poland; 6Amgen
Inc., Thousand Oaks, CA, USA; 7University Hospital of Lausanne, Lausanne, Switzerland; 8Centro TIEMPO, Buenos Aires, Argentina; 9Sahlgrenska University Hospital, Göteburg, Sweden; 10Universidade Federal do Paraná, Curitiba, Brazil; 11University
of Liège, Liège, Belgium; 12St. Vincent's Hospital, Vienna, Austria; 13Hospital Universitario La Fe, Valencia, Spain; 14Paris Descartes University, Paris, France; 15San Francisco Coordinating Center, CPMC Research Institute, San Francisco, CA, USA;
16Leiden University Medical Center, Leiden, The Netherlands