Osteoporosis :: Aclasta Reclast prevents additional fractures in hip fracture patients with osteoporosis

Results of the first-ever clinical study in patients with osteoporosis who suffered a hip fracture show that a once-yearly infusion of Aclasta®/Reclast® (zoledronic acid 5 mg)[*] reduced the risk of subsequent fractures by 35% compared to patients treated with placebo.

The study found the risk of death was significantly reduced by 28% in the Aclasta patient group compared to the placebo group (101 vs. 141 deaths). This is especially important since almost a quarter of people over age 50 who suffer a hip fracture die within one year[2]. Despite this significant risk, few patients with hip fractures are diagnosed and treated for osteoporosis following a hip fracture[1].

The landmark study, involving more than 2,100 men and women, was published online today as an early release article in The New England Journal of Medicine and presented simultaneously at the annual meeting of the American Society for Bone & Mineral Research (ASBMR).

Aclasta, which was recently approved in the US under the brand name Reclast®, belongs to a class of drugs called bisphosphonates used to treat osteoporosis – the most common metabolic bone disease affecting more than 200 million people worldwide[3]. Unlike oral bisphosphonates which are taken daily, weekly or monthly, Aclasta is given as a once-yearly infusion completed in approximately 15 minutes.

“Unfortunately, at present few people who experience hip fractures are evaluated and treated for osteoporosis,” said Steven Boonen, senior author of the NEJM publication and Professor of Medicine at the Leuven University Centre for Metabolic Bone Diseases and Division of Geriatric Medicine in Belgium.

“This unique study highlights a novel approach to treating osteoporosis and proves that a once-yearly infusion of Aclasta may significantly advance the way we treat our patients with osteoporosis,” Dr. Boonen said.

Data from the new study, called the Recurrent Fracture Trial, will be submitted to regulatory authorities worldwide by the end of 2007 to broaden the treatment indication for Aclasta/Reclast.

“This study builds upon the body of evidence for Aclasta/Reclast and is the first to show that osteoporosis treatment after a hip fracture can have a positive impact on the lives of patients,” said James Shannon, MD, Global Head of Development at Novartis Pharma AG. “Aclasta is an important new treatment option for millions of people who suffer from the potentially life-threatening consequences of this condition.”

In the Recurrent Fracture Trial, Aclasta significantly reduced the risk of all types of new clinical fractures by 35% compared to placebo (92 vs. 139 fractures). The risk of new spine fractures was reduced by 46% (21 vs. 39 fractures) and new non-spine fractures (such as hip, wrist, arm, leg, rib) by 27% (79 vs. 107 fractures). The study was not designed to measure significant differences in hip fractures, but a trend was seen toward a reduction in new hip fractures (23 vs. 33 fractures, or a 30% reduction).

Fewer patients who received Aclasta died after suffering a fracture than those treated with placebo (9.6% vs. 13.3%). This was probably due to a range of factors, but may have been partly related to the effect of Aclasta in reducing new fractures in patients who had previously had a hip fracture. Further investigation is needed to understand this finding more clearly.

This study further supports the favorable safety profile of Aclasta. Analysis of key safety parameters, including kidney and cardiovascular safety (including atrial fibrillation), found Aclasta to be comparable with placebo. Incidence of renal events was similar between the Aclasta and placebo groups (6.2% vs. 5.6% respectively). Atrial fibrillation serious adverse events occurred in 1.1% of Aclasta-treated patients compared to 1.3% of placebo-treated patients. No cases of osteonecrosis of the jaw (ONJ) were seen in the Recurrent Fracture Trial. The most common adverse events with Aclasta were transient post-dose symptoms such as fever and muscle pain.

The Recurrent Fracture Trial was an international Phase III study designed to evaluate the efficacy and safety of Aclasta in preventing subsequent fractures in men and women aged 50 to 98 following the surgical repair of a low-trauma hip fracture (i.e. caused by a fall from standing height or less, or equivalent force).

The primary endpoint of the study was to determine the effect of Aclasta on new clinical fractures following hip fracture. Secondary endpoints included the change in bone mineral density (BMD) in the non-fractured hip; vertebral, non-vertebral and hip fractures; and pre-specified safety endpoints, including death.

Reclast was approved by the US Food and Drug Administration (FDA) on August 17, 2007 as the first and only once-yearly treatment for postmenopausal osteoporosis. In July 2007, the Committee for Medicinal Products for Human Use (CHMP) issued a positive opinion recommending approval in the European Union. The European Commission generally follows the CHMP’s recommendations and is expected to soon issue a decision.

The US and EU regulatory submissions were based on results of the Pivotal Fracture Trial, involving more than 7,700 women. In this study, published in The New England Journal of Medicine in May 2007, Aclasta was shown to increase bone strength and reduce fractures in areas of the body typically affected by osteoporosis, including the hip, spine and non-spine (i.e. hip, wrist, arm, leg, rib). Aclasta is the only treatment approved to reduce the risk of fractures across all these key sites. The study showed that Aclasta reduced the risk of spine fractures by 70% and hip fractures by 41%[4].

Aclasta is approved in more than 60 countries including the US, Canada and the EU for the treatment of Paget’s disease, the second most common metabolic bone disorder. Additional studies are ongoing to examine the use of Aclasta to treat corticosteroid-induced osteoporosis, male osteoporosis and bone loss in postmenopausal women with osteopenia.

The active ingredient in Aclasta is zoledronic acid, which is also available in a different dosage under the brand name Zometa® (zoledronic acid 4 mg) for use in certain oncology indications.

[1] Gardner MJ, Brophy RH, Demetrakopoulos D, et al. Interventions to improve osteoporosis treatment following hip fracture. Journal of Bone and Joint Surgery. 2005; 87-A: 3-7.
[2] National Osteoporosis Foundation. About Osteoporosis: Fast Facts. Available at: http://www.nof.org/osteoporosis/diseasefacts.htm Accessed on August 31, 2007.
[3] Cooper C. Epidemiology of osteoporosis. Osteoporosis Int 1999;9 (Suppl2):S2-8 Available at http://www.iofbonehealth.org/health-professionals/about-osteoporosis/epidemiology.html. Accessed on September 1, 2007.
[4] Black D, Delmas, S, Eastell R, et al for the HORIZON Pivotal Fracture Trial. Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis. NEJM 2007; 356(18):1809-22.

[*] The tradename in the US is Reclast®

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