Study of KRN23 (Burosumab), a Recombinant Fully Human Monoclonal Antibody Against Fibroblast Growth Factor 23 (FGF23), in Pediatric Subjects With X-linked Hypophosphatemia (XLH)

NCT ID: NCT02163577

Last Updated: 2024-05-06

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

52 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-07-02

Study Completion Date

2018-10-30

Brief Summary

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The objectives of the study are to:

* Identify a dose and dosing regimen of burosumab, based on safety and pharmacodynamic (PD) effect, in pediatric XLH participants
* Establish the safety profile of burosumab for the treatment of children with XLH including ectopic mineralization risk, cardiovascular effects, and immunogenicity profile
* Characterize the pharmacokinetic (PK)/PD profile of the KRN23 doses tested in the monthly (Q4) and biweekly (Q2) dose regimens in pediatric XLH patients
* Determine the PD effects of burosumab treatment on markers of bone health in pediatric XLH patients
* Obtain a preliminary assessment of the clinical effects of burosumab on bone health and deformity, muscle strength, and motor function
* Obtain a preliminary assessment of the effects of burosumab on participant-reported outcomes, including pain, disability, and quality of life in pediatric XLH patients
* Evaluate the long-term safety and efficacy of burosumab

Detailed Description

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Conditions

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X-linked Hypophosphatemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Burosumab Q2W

Burosumab subcutaneous (SC) injections every 2 weeks (Q2W). Dose was determined by the participant's weight and prescribed dose by their study doctor.

Group Type EXPERIMENTAL

burosumab

Intervention Type BIOLOGICAL

solution for SC injection

Burosumab Q4W Then Q2W

Burosumab SC injections every 4 weeks (Q4W). Dose was determined by the participant's weight and prescribed dose by their study doctor. Participants in Q4W were to switch to Q2W beginning with Week 64 dosing.

Group Type EXPERIMENTAL

burosumab

Intervention Type BIOLOGICAL

solution for SC injection

Interventions

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burosumab

solution for SC injection

Intervention Type BIOLOGICAL

Other Intervention Names

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KRN23 Crysvita® UX023

Eligibility Criteria

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Inclusion Criteria

1. Male or female, aged 5 - 12 years, inclusive, with open growth plates
2. Tanner stage of 2 or less based on breast and testicular development
3. Diagnosis of XLH supported by ONE of the following:

* Confirmed Phosphate regulating gene with homology to endopeptidases located on the X chromosome (PHEX) mutation in the patient or a directly related family member with appropriate X-linked inheritance
* Serum FGF23 level \> 30 pg/mL by Kainos assay
4. Biochemical findings associated with XLH including:

* Serum phosphorus ≤ 2.8 mg/dL (0.904 mmol/L)\*
* Serum creatinine within age-adjusted normal range\*
5. Standing height \< 50th percentile for age and gender using local normative data.
6. Radiographic evidence of active bone disease including rickets in the wrists and/or knees, AND/OR femoral/tibial bowing, OR, for expansion subjects, a Rickets Severity Score (RSS) score in the knee of at least 1.5 as determined by central read.
7. Willing to provide access to prior medical records for the collection of historical growth, biochemical and radiographic data, and disease history.
8. Provide written or verbal assent (if possible) and written informed consent by a legally authorized representative after the nature of the study has been explained, and prior to any research-related procedures.
9. Must, in the opinion of the investigator, be willing and able to complete all aspects of the study, adhere to the study visit schedule and comply with the assessments.
10. Females who have reached menarche must have a negative pregnancy test at Screening and undergo additional pregnancy testing during the study. If sexually active, male and female subjects must be willing to use an acceptable method of contraception for the duration of the study.

* Criteria to be determined based on overnight fasting (minimum 4 hours) values collected at Screening Visit 2

Exclusion

1. Use of a pharmacologic vitamin D metabolite or analog (e.g. calcitriol, doxercalciferol, alfacalcidiol, and paricalcitol) within 14 days prior to Screening Visit 2; washout will take place during the Screening Period
2. Use of oral phosphate within 7 days prior to Screening Visit 2; washout will take place during the Screening Period
3. Use of calcimimetics, aluminum hydroxide antacids (e.g. Maalox® and Mylanta®), systemic corticosteroids, and thiazides within 7 days prior to Screening Visit 1
4. Use of growth hormone therapy within 3 months before Screening Visit 1
5. Use of bisphosphonates for 6 months or more in the 2 years prior to Screening Visit 1
6. Presence of nephrocalcinosis on renal ultrasound graded ≥ 3 based on the following scale: 0 = Normal 1 = Faint hyperechogenic rim around the medullary pyramids 2 = More intense echogenic rim with echoes faintly filling the entire pyramid 3 = Uniformly intense echoes throughout the pyramid 4 = Stone formation: solitary focus of echoes at the tip of the pyramid
7. Planned or recommended orthopedic surgery, including staples, 8-plates or osteotomy, within the clinical trial period
8. Hypocalcemia or hypercalcemia, defined as serum calcium levels outside the age-adjusted normal limits \*
9. Evidence of tertiary hyperparathyroidism as determined by the Investigator
10. Use of medication to suppress parathyroid hormone (PTH) (e.g. Sensipar®, cinacalcet, calcimimetics) within 2 months prior to Screening Visit 1
11. Presence or history of any condition that, in the view of the investigator, places the subject at high risk of poor treatment compliance or of not completing the study
12. Presence of a concurrent disease or condition that would interfere with study participation or affect safety
13. Previously diagnosed with human immunodeficiency virus antibody, hepatitis B surface antigen, and/or hepatitis C antibody
14. History of recurrent infection or predisposition to infection, or of known immunodeficiency
15. Use of a therapeutic monoclonal antibody within 90 days prior to Screening Visit 1 or history of allergic or anaphylactic reactions to any monoclonal antibody
16. Presence or history of any hypersensitivity to recombinant human immunoglobulin G1 (IgG1) monoclonal antibody to FGF23 (burosumab) excipients that, in the judgment of the investigator, places the subject at increased risk for adverse effects
17. Use of any investigational product or investigational medical device within 30 days prior to screening, or requirement for any investigational agent prior to completion of all scheduled study assessments

* Criteria to be determined based on overnight fasting (minimum 4 hours) values collected at Screening Visit 2
Minimum Eligible Age

5 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kyowa Kirin Co., Ltd.

INDUSTRY

Sponsor Role collaborator

Kyowa Kirin, Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Medical Director

Role: STUDY_DIRECTOR

Ultragenyx Pharmaceutical Inc

Locations

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University of California San Francisco

San Francisco, California, United States

Site Status

Yale University School of Medicine

New Haven, Connecticut, United States

Site Status

Indiana University Hospital

Indianapolis, Indiana, United States

Site Status

Shriners Hospital for Children

St Louis, Missouri, United States

Site Status

Bicetre Hospital

Le Kremlin-Bicêtre, , France

Site Status

University Medical Center Groningen

Groningen, , Netherlands

Site Status

Royal Manchester Hospital

Manchester, Lancashire, United Kingdom

Site Status

Birmingham Children's University

Birmingham, , United Kingdom

Site Status

Great Ormond Street Hospital

London, , United Kingdom

Site Status

Countries

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United States France Netherlands United Kingdom

References

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Linglart A, Imel EA, Whyte MP, Portale AA, Hogler W, Boot AM, Padidela R, Van't Hoff W, Gottesman GS, Chen A, Skrinar A, Scott Roberts M, Carpenter TO. Sustained Efficacy and Safety of Burosumab, a Monoclonal Antibody to FGF23, in Children With X-Linked Hypophosphatemia. J Clin Endocrinol Metab. 2022 Feb 17;107(3):813-824. doi: 10.1210/clinem/dgab729.

Reference Type DERIVED
PMID: 34636899 (View on PubMed)

Mao M, Carpenter TO, Whyte MP, Skrinar A, Chen CY, San Martin J, Rogol AD. Growth Curves for Children with X-linked Hypophosphatemia. J Clin Endocrinol Metab. 2020 Oct 1;105(10):3243-9. doi: 10.1210/clinem/dgaa495.

Reference Type DERIVED
PMID: 32721016 (View on PubMed)

Carpenter TO, Whyte MP, Imel EA, Boot AM, Hogler W, Linglart A, Padidela R, Van't Hoff W, Mao M, Chen CY, Skrinar A, Kakkis E, San Martin J, Portale AA. Burosumab Therapy in Children with X-Linked Hypophosphatemia. N Engl J Med. 2018 May 24;378(21):1987-1998. doi: 10.1056/NEJMoa1714641.

Reference Type DERIVED
PMID: 29791829 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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UX023-CL201

Identifier Type: -

Identifier Source: org_study_id

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