Condition or disease | Intervention/treatment | Phase |
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X-linked Hypophosphatemia | Drug: Burosumab | Phase 3 |
XLH is a rare, genetic disorder that is serious, chronically debilitating and represents an unmet medical need. XLH is the most common inherited form of rickets and the most common inherited defect in renal tubular phosphate transport. XLH is transmitted as an X-linked dominant disorder. Mutations resulting in the loss of function of PHEX form the genetic basis for XLH. More than 300 different PHEX gene mutations have been identified in patients with XLH (PHEXdb); however, few definitive correlations have been observed between specific mutations and phenotypic severity.
Patients with XLH have hypophosphatemia due to excessive serum FGF23 levels. FGF23 reduces serum phosphorus levels by two distinct mechanisms of action. The primary mechanism is to inhibit phosphate reabsorption in the proximal tubule of the kidney. The secondary mechanism is to decrease phosphate absorption by the small intestine through the inhibition of 1,25(OH)2D production in the kidney.
Burosumab has the potential to block or reduce FGF23 action and improve phosphate homeostasis in XLH patients. Burosumab binds the amino-terminal domain of FGF23 that interacts with the FGF-binding portion of the combination FGFR1/Klotho receptor, preventing FGF23 from binding to and signaling from its receptor. Both intact and fragmented FGF23 polypeptides are immunoprecipitated with burosumab. By inhibiting FGF23, burosumab restores tubular reabsorption of phosphate (as measured by the ratio of renal tubular maximum reabsorption rate of phosphate to glomerular filtration rate [TmP/GFR]) from the kidney and increases the production of 1,25(OH)2D that also enhances intestinal absorption of phosphate. The dual action on kidney reabsorption and intestinal absorption improves serum phosphorus levels, which is expected to improve bone mineralization and reduce the diverse bone and non-bone manifestations associated with hypophosphatemia in XLH patients.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 38 participants |
Allocation: | N/A |
Intervention Model: | Single Group Assignment |
Intervention Model Description: | Open-label, international, multicenter |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Phase 3b Open-label Study of the Anti-FGF23 Antibody, Burosumab (KRN23) in Adult Patients With X-linked Hypophosphatemia (XLH) |
Actual Study Start Date : | March 7, 2019 |
Estimated Primary Completion Date : | December 31, 2021 |
Estimated Study Completion Date : | January 31, 2022 |
Arm | Intervention/treatment |
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Open label
All subjects will be administered subcutaneously burosumab every 4 weeks at the dosage defined in study UX023-CL303 or UX023-CL304 until December 2021 or when the drug becomes commercially available.
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Drug: Burosumab
Burosumab is a sterile, clear, colourless and preservative free solution supplied in single-use 5ml vials containing 1mL of burosumab at a concentration of 30mg/mL
Other Names:
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Ages Eligible for Study: | 18 Years to 70 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Contact: Development Division Project Management Department | 609-919-1100 | kkd.clintrial.82@kyowakirin.com |
France | |
CHU de Bicetre | Recruiting |
Le Kremlin-Bicêtre, France, 94275 | |
Contact: Hubert Lesur | |
Principal Investigator: Peter Kamenicky | |
Hopital Lariboisiere | Enrolling by invitation |
Paris, France, 75010 | |
Hopital Cochin | Enrolling by invitation |
Paris, France, 75014 | |
Ireland | |
St. Vincent's University Hospital | Enrolling by invitation |
Dublin, Ireland, D04 T6F4 | |
Italy | |
Azienda ospedaliera universitaria Careggi | Enrolling by invitation |
Florence, Italy, 50139 | |
United Kingdom | |
Western General Hospital | Enrolling by invitation |
Edinburgh, United Kingdom, EH4 2XU | |
National Hospital for Neurology and Neurosurgery-University College London Hospitals NHS Foundation Trust | Enrolling by invitation |
London, United Kingdom, WC1N 3BG | |
Nuffield Orthopaedic Centre - Oxford University Hospitals Nhs Trust | Enrolling by invitation |
Oxford, United Kingdom, OX3 7LD | |
Northen General Hospital | Not yet recruiting |
Sheffield, United Kingdom, S5 7AU | |
Contact: Julie Walker | |
Principal Investigator: Jennifer Walsh | |
Royal National Orthopaedic Hospital NHS Trust | Enrolling by invitation |
Stanmore, United Kingdom, HA7 4LP |
Principal Investigator: | Peter Kamenicky | CHU de Bicêtre |
Tracking Information | |||||
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First Submitted Date ICMJE | October 29, 2018 | ||||
First Posted Date ICMJE | April 18, 2019 | ||||
Last Update Posted Date | November 27, 2019 | ||||
Actual Study Start Date ICMJE | March 7, 2019 | ||||
Estimated Primary Completion Date | December 31, 2021 (Final data collection date for primary outcome measure) | ||||
Current Primary Outcome Measures ICMJE |
Proportion of subjects achieving mean serum phosphorus levels above the LLN (2.5mg/dL[0.81mmol/L]), as averaged across dose cycles between baseline and their last administered dose. [ Time Frame: Serum phosphorous levels will be monitored from Screening and every 12 weeks until the end of the study, at approximately 144 weeks. ] To establish the effect of burosumab treatment on maintaining serum phosphorus levels to within normal range in adults with XLH.
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Original Primary Outcome Measures ICMJE |
Proportion of subjects achieving mean serum phosphorus levels above the LLN (2.5mg/dL[0.81mmol/L]), as averaged across dose cycles between baseline and their last administered dose. [ Time Frame: Serum phosphorous levels will be monitored from Screening and every 12 weeks until the end of the study, at approximately 88 weeks. ] To establish the effect of burosumab treatment on maintaining serum phosphorus levels to within normal range in adults with XLH.
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Change History | |||||
Current Secondary Outcome Measures ICMJE |
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Original Secondary Outcome Measures ICMJE |
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Current Other Pre-specified Outcome Measures | Not Provided | ||||
Original Other Pre-specified Outcome Measures | Not Provided | ||||
Descriptive Information | |||||
Brief Title ICMJE | Study of the Anti-FGF23 Antibody, Burosumab, in Adults With XLH | ||||
Official Title ICMJE | A Phase 3b Open-label Study of the Anti-FGF23 Antibody, Burosumab (KRN23) in Adult Patients With X-linked Hypophosphatemia (XLH) | ||||
Brief Summary | This is phase 3b open-label, international, multicenter study to continue to monitor the long-term safety and efficacy of burosumab in adult patients with XLH that participated in previous clinical trials with burosumab (UX023-CL303 / UX023-CL304). | ||||
Detailed Description |
XLH is a rare, genetic disorder that is serious, chronically debilitating and represents an unmet medical need. XLH is the most common inherited form of rickets and the most common inherited defect in renal tubular phosphate transport. XLH is transmitted as an X-linked dominant disorder. Mutations resulting in the loss of function of PHEX form the genetic basis for XLH. More than 300 different PHEX gene mutations have been identified in patients with XLH (PHEXdb); however, few definitive correlations have been observed between specific mutations and phenotypic severity. Patients with XLH have hypophosphatemia due to excessive serum FGF23 levels. FGF23 reduces serum phosphorus levels by two distinct mechanisms of action. The primary mechanism is to inhibit phosphate reabsorption in the proximal tubule of the kidney. The secondary mechanism is to decrease phosphate absorption by the small intestine through the inhibition of 1,25(OH)2D production in the kidney. Burosumab has the potential to block or reduce FGF23 action and improve phosphate homeostasis in XLH patients. Burosumab binds the amino-terminal domain of FGF23 that interacts with the FGF-binding portion of the combination FGFR1/Klotho receptor, preventing FGF23 from binding to and signaling from its receptor. Both intact and fragmented FGF23 polypeptides are immunoprecipitated with burosumab. By inhibiting FGF23, burosumab restores tubular reabsorption of phosphate (as measured by the ratio of renal tubular maximum reabsorption rate of phosphate to glomerular filtration rate [TmP/GFR]) from the kidney and increases the production of 1,25(OH)2D that also enhances intestinal absorption of phosphate. The dual action on kidney reabsorption and intestinal absorption improves serum phosphorus levels, which is expected to improve bone mineralization and reduce the diverse bone and non-bone manifestations associated with hypophosphatemia in XLH patients. |
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Study Type ICMJE | Interventional | ||||
Study Phase ICMJE | Phase 3 | ||||
Study Design ICMJE | Allocation: N/A Intervention Model: Single Group Assignment Intervention Model Description: Open-label, international, multicenter Masking: None (Open Label)Primary Purpose: Treatment |
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Condition ICMJE | X-linked Hypophosphatemia | ||||
Intervention ICMJE | Drug: Burosumab
Burosumab is a sterile, clear, colourless and preservative free solution supplied in single-use 5ml vials containing 1mL of burosumab at a concentration of 30mg/mL
Other Names:
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Study Arms ICMJE | Open label
All subjects will be administered subcutaneously burosumab every 4 weeks at the dosage defined in study UX023-CL303 or UX023-CL304 until December 2021 or when the drug becomes commercially available.
Intervention: Drug: Burosumab
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Publications * | Not Provided | ||||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||
Recruitment Status ICMJE | Recruiting | ||||
Estimated Enrollment ICMJE |
38 | ||||
Original Estimated Enrollment ICMJE | Same as current | ||||
Estimated Study Completion Date ICMJE | January 31, 2022 | ||||
Estimated Primary Completion Date | December 31, 2021 (Final data collection date for primary outcome measure) | ||||
Eligibility Criteria ICMJE |
Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender ICMJE |
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Ages ICMJE | 18 Years to 70 Years (Adult, Older Adult) | ||||
Accepts Healthy Volunteers ICMJE | No | ||||
Contacts ICMJE |
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Listed Location Countries ICMJE | France, Ireland, Italy, United Kingdom | ||||
Removed Location Countries | |||||
Administrative Information | |||||
NCT Number ICMJE | NCT03920072 | ||||
Other Study ID Numbers ICMJE | BUR02 | ||||
Has Data Monitoring Committee | No | ||||
U.S. FDA-regulated Product |
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IPD Sharing Statement ICMJE |
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Responsible Party | Kyowa Kirin Pharmaceutical Development Ltd | ||||
Study Sponsor ICMJE | Kyowa Kirin Pharmaceutical Development Ltd | ||||
Collaborators ICMJE | Not Provided | ||||
Investigators ICMJE |
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PRS Account | Kyowa Kirin Pharmaceutical Development Ltd | ||||
Verification Date | November 2019 | ||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |