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A Randomized, Double‐Blind, Placebo‐Controlled, Phase 3 Trial Evaluating the Efficacy of Burosumab, an Anti‐FGF23 Antibody, in Adults With X‐Linked Hypophosphatemia: Week 24 Primary Analysis
Author(s) -
Insogna Karl L,
Briot Karine,
Imel Erik A,
Kamenický Peter,
Ruppe Mary D,
Portale Anthony A,
Weber Thomas,
Pitukcheewat Pisit,
Cheong Hae Il,
Jan de Beur Suzanne,
Imanishi Yasuo,
Ito Nobuaki,
Lachmann Robin H,
Tanaka Hiroyuki,
Perwad Farzana,
Zhang Lin,
Chen ChaoYin,
TheodoreOklota Christina,
Mealiffe Matt,
San Martin Javier,
Carpenter Thomas O
Publication year - 2018
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.3475
Subject(s) - hypophosphatemia , placebo , medicine , womac , osteomalacia , gastroenterology , short stature , fibroblast growth factor 23 , osteoarthritis , surgery , parathyroid hormone , osteoporosis , pathology , alternative medicine , calcium
ABSTRACT In X‐linked hypophosphatemia (XLH), inherited loss‐of‐function mutations in the PHEX gene cause excess circulating levels of fibroblast growth factor 23 (FGF23), leading to lifelong renal phosphate wasting and hypophosphatemia. Adults with XLH present with chronic musculoskeletal pain and stiffness, short stature, lower limb deformities, fractures, and pseudofractures due to osteomalacia, accelerated osteoarthritis, dental abscesses, and enthesopathy. Burosumab, a fully human monoclonal antibody, binds and inhibits FGF23 to correct hypophosphatemia. This report summarizes results from a double‐blind, placebo‐controlled, phase 3 trial of burosumab in symptomatic adults with XLH. Participants with hypophosphatemia and pain were assigned 1:1 to burosumab 1 mg/kg ( n = 68) or placebo ( n = 66) subcutaneously every 4 weeks (Q4W) and were comparable at baseline. Across midpoints of dosing intervals, 94.1% of burosumab‐treated participants attained mean serum phosphate concentration above the lower limit of normal compared with 7.6% of those receiving placebo ( p < 0.001). Burosumab significantly reduced the Western Ontario and the McMaster Universities Osteoarthritis Index (WOMAC) stiffness subscale compared with placebo (least squares [LS] mean ± standard error [SE] difference, –8.1 ± 3.24; p = 0.012). Reductions in WOMAC physical function subscale (–4.9 ± 2.48; p = 0.048) and Brief Pain Inventory worst pain (–0.5 ± 0.28; p = 0.092) did not achieve statistical significance after Hochberg multiplicity adjustment. At week 24, 43.1% (burosumab) and 7.7% (placebo) of baseline active fractures were fully healed; the odds of healed fracture in the burosumab group was 16.8‐fold greater than that in the placebo group ( p < 0.001). Biochemical markers of bone formation and resorption increased significantly from baseline with burosumab treatment compared with placebo. The safety profile of burosumab was similar to placebo. There were no treatment‐related serious adverse events or meaningful changes from baseline in serum or urine calcium, intact parathyroid hormone, or nephrocalcinosis. These data support the conclusion that burosumab is a novel therapeutic addressing an important medical need in adults with XLH.© 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.