Abstract
Conventional therapy for hypoparathyroidism consisting of active vitamin D and calcium aims to alleviate hypocalcemia but fails to restore normal parathyroid hormone (PTH) physiology. PTH replacement therapy is the ideal physiologic treatment for hypoparathyroidism. The double-blind, placebo-controlled, 26-week, phase 3 PaTHway trial assessed the efficacy and safety of PTH replacement therapy for hypoparathyroidism individuals with the investigational drug TransCon PTH (palopegteriparatide). Participants (n = 84) were randomized 3:1 to once-daily TransCon PTH (initially 18 μg/d) or placebo, both co-administered with conventional therapy. The study drug and conventional therapy were titrated according to a dosing algorithm guided by serum calcium. The composite primary efficacy endpoint was the proportion of participants at week 26 who achieved normal albumin-adjusted serum calcium levels (8.3–10.6 mg/dL), independence from conventional therapy (requiring no active vitamin D and ≤600 mg/d of calcium), and no increase in study drug over 4 weeks before week 26. Other outcomes of interest included health-related quality of life measured by the 36-Item Short Form Survey (SF-36), hypoparathyroidism-related symptoms, functioning, and well-being measured by the Hypoparathyroidism Patient Experience Scale (HPES), and urinary calcium excretion. At week 26, 79% (48/61) of participants treated with TransCon PTH versus 5% (1/21) wiplacebo met the composite primary efficacy endpoint (p < 0.0001). TransCon PTH treatment demonstrated a significant improvement in all key secondary endpoint HPES domain scores (all p < 0.01) and the SF-36 Physical Functioning subscale score (p = 0.0347) compared with placebo. Additionally, 93% (57/61) of participants treated with TransCon PTH achieved independence from conventional therapy. TransCon PTH treatment normalized mean 24-hour urine calcium. Overall, 82% (50/61) treated with TransCon PTH and 100% (21/21) wiplacebo experienced adverse events; most were mild (46%) or moderate (46%). No study drug-related withdrawals occurred. In conclusion, TransCon PTH maintained normocalcemia while permitting independence from conventional therapy and was well-tolerated in individuals with hypoparathyroidism.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Bone and Mineral Research |
| Vol/bind | 38 |
| Udgave nummer | 1 |
| Sider (fra-til) | 14-25 |
| Antal sider | 12 |
| ISSN | 0884-0431 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:This work was supported by Ascendis Pharma Bone Diseases A/S, Hellerup, Denmark. The ClinicalTrials.gov number is NCT04009291. The authors thank the trial participants and their families, investigators, and the trial staff. Medical writing support was provided by Kristin Hirahatake, PhD, and Nayna Sanathara, PhD, of Ascendis Pharma Inc.
Funding Information:
This work was supported by Ascendis Pharma Bone Diseases A/S, Hellerup, Denmark. The ClinicalTrials.gov number is NCT04009291. The authors thank the trial participants and their families, investigators, and the trial staff. Medical writing support was provided by Kristin Hirahatake, PhD, and Nayna Sanathara, PhD, of Ascendis Pharma Inc.
Publisher Copyright:
© 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).