Bone Mineral Density Response With Denosumab in Combination With Standard or High-Dose Teriparatide: The DATA-HD RCT

• Published in: The journal of clinical endocrinology and metabolism 2020-03, Vol.105 (3), p.890-897
• Main Authors: Ramchand, Sabashini K, David, Natalie L, Leder, Benjamin Z, Tsai, Joy N
• Format: Article
• Language: English
• Subjects: Absorptiometry; Absorptiometry, Photon; Aged; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - administration & dosage; Bone diseases; Bone mineral density; Bones; Clinical s; Comparative analysis; Denosumab; Denosumab - administration & dosage; Density; Dose-Response Relationship, Drug; Drug therapy; Drug therapy, Combination; Drug Therapy, Combination - methods; Dual energy X-ray absorptiometry; Female; Femur; Femur Neck - diagnostic imaging; Femur Neck - drug effects; Femur Neck - physiopathology; Hip; Humans; Immunotherapy; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - drug effects; Lumbar Vertebrae - physiopathology; Middle Aged; Monoclonal antibodies; Osteoporosis; Osteoporosis, Postmenopausal - complications; Osteoporosis, Postmenopausal - diagnosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporosis, Postmenopausal - physiopathology; Parathyroid hormone; Post-menopause; Spine (lumbar); Teriparatide - administration & dosage; Treatment Outcome
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/clinem/dgz163

Abstract Context In the Denosumab and High-Dose Teriparatide Administration (DATA-HD) study, we reported that 15 months of combined high-dose (HD) teriparatide and denosumab increased mean areal bone mineral density (aBMD) at the hip and spine more than combined denosumab and standard-dose (SD) teriparatide. Objective In the current analysis, we compare the individual rates of aBMD response between the treatment groups. Design Single-site, open-label, randomized controlled trial in which postmenopausal women received either teriparatide 20-μg daily (SD) or 40-μg daily (HD) given months 0 through 9, overlapped with denosumab 60 mg, given months 3 through 15 (15 months’ total duration). The proportion of participants in the SD and HD groups experiencing total hip, femoral neck, and lumbar spine aBMD gains of >3%, >6%, and >9% were compared. Participants Postmenopausal women with osteoporosis completing all study visits (n = 60). Main outcome measure(s) aBMD (dual x-ray absorptiometry). Results At the end of the 15-month treatment period, a higher proportion of women in the HD group had aBMD increases >3% (83% vs. 58%, P = .037) and >6% (45% vs. 19%, P = .034) at the total hip, and >3% at the femoral neck (86% vs. 63%, P = .044). At the lumbar spine, >3% response rates were similar, whereas the >6% and >9% response rates were greater in the HD group (100% vs. 79%, P = .012 and 93% vs. 59%, P = .003, respectively). Conclusion Compared with the SD regimen, more women treated with the HD regimen achieved clinically meaningful and rapid gains in hip and spine aBMD. These results suggest that this approach may provide unique benefits in the treatment of postmenopausal osteoporosis.