Fibrous Dysplasia, McCune Albright Syndrome
Conditions
Brief summary
Fibrous Dysplasia/McCune-Albright syndrome (FD/MAS) is a rare disease, consisting of the replacement of normal bone tissue with fibrous tissue. FD lesions may be isolated in one or more bones or may be associated with endocrinopathies in McCune-Albright syndrome. Bone lesions constitute of weak bone tissue, leading to higher risk of fractures, pain and decreased quality of life. There is no cure for FD lesions and current therapies failed to soothe patients' complaints or to display any effect on progression of the lesions on imaging. However, the RANKL-inhibitor Denosumab demonstrated encouraging results in mouse models and in off-label clinical use, leading to clinical, biochemical and radiographical improvements. Study's aim is to investigate whether 3-monthly Denosumab will improve the clinical, radiological and biochemical manifestations of FD bone lesions.
Detailed description
Eligible patients will be randomized to treatment with either subcutaneous Dmab 120mg or placebo at baseline and 3 months in a blinded fashion. At 6 months, after 2 injections, patients with pain score \<4 will exit the study to discontinue study medication and proceed in usual care, while patients with pain score ≥4 or lesional growth will be offered Dmab 120 mg at 6 and 9 months in an open-label design.
Interventions
DRUGDenosumab 120 Mg/1.7 Ml Inj
Denosumab randomized at baseline and after 3 months at 6 and 9 months in case of open label
DRUGPlacebo
placebo randomized at baseline and after 3 months
Sponsors
Natasha Appelman-Dijkstra
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Symptomatic patients with established diagnosis of FD/MAS and closed growth plates(\>18 years) * Pain in the region of an FD localization, not responding to adequate pain treatment and without mechanical component e.g. impending fracture * Pain score from FD lesion for maximum or average pain on VAS ≥ 4 * Increased lesional activity defined as increased bone turnover markers (ALP, P1NP or CTX) or increased activity on Na\[18F\]-PET/CT or bone scintigraphy in at least one lesion * Normal levels of calcium, parathyroid hormone and vitamin D (supplementation is allowed) * Treated hypophosphatemia (defined as \>0.7 at two separate measures) * good dental health (last check within the last 12 months)
Exclusion criteria
* Active pregnancy wish, pregnancy or nursing * Pain not related to FD * Uncontrolled endocrine disease * Untreated vitamin D deficiency, hypocalcemia or hypophosphatemia * Previous use of bisphosphonates or Dmab \< 6 months before inclusion ('6 months wash out') * Previously reported severe side effects on Dmab * Inability to fulfil study requirements * Poor untreated dental health without intention to get treatment * Treatment with other bone influencing drugs, such as high doses corticosteroids
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Denosumab effect on maximal pain score | at baseline, 3 months and after 6 months and in case of open label treatment after 9 and 12 months | Evaluation of maximal pain score changes after treatment, assessed by Brief Pain Inventory (scale 0 to 10; 0-no pain, 10 worst pain) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To evaluate the number of patients with 50% reduction of maximal pain (BPI) | at baseline, 3 months and after 6 months and in case of open label treatment after 9 and 12 months | Evaluation of the number of patients with 50% reduction of maximal pain score changes after treatment, asseses by Brief Pain Inventory (scale 0 to 10; 0-no pain, 10 worst pain) |
| Denosumab effect on quality of life | at baseline, 3 months and after 6 months and in case of open label treatment after 9 and 12 months | Evaluation of Denosumab effect on quality of life, assessed with validated questionnaire SF-36 (scale 0-100, higher scores indicate better health status) |
| Denosumab effect on average weekly pain score | every week from baseline, through study completion, an average of 1 year | Evaluation of Denosumab effect on average weekly pain score assessed through a pain diary with VAS score (scale 0 to 10) |
| Denosumab effect on Physical activity assessment assessed through Health Assessment Questionnaire - Disability Index | baseline, 3 months and 6 months, and in case of open label treatment after 9 and 12 months | Evaluation of Denosumab effect on on Physical activity assessment (Health Assessment Questionnaire - Disability Index: Health state index scores generally range from less than 0 (where 0 is a health state equivalent to death; negative values are valued as worse than death) to 1 (perfect health), with higher scores indicating higher health utility, though health state preferences can differ between countries. |
| Denosumab effect on Physical activity assessment assessed through screenshot of pedometer | baseline, 3 months and 6 months, and in case of open label treatment after 9 and 12 months | Evaluation of Denosumab effect on on Physical activity assessment ( screenshot of pedometer of activity during the last week on smartphone, unit measure: number of steps during the last week) |
| Evaluation of prevalence of possible neuropathic component of the reported pain | baseline, 3 months and 6 months and in case of open label treatment after 9 and 12 months | to evaluate the prevalence of possible neuropathic component of the reported pain through Pain Detect questionnaire (It is scored from 0 to 38, with total scores of less than 12 considered to represent nociceptive pain, 13-18 possible NeP, and \>19 representing \>90% likelihood of Neuropathic pain) |
| To investigate the number of analgesics used for pain | baseline, 3 months and 6 months and in case of open label treatment after 9 and 12 months | number of used analgesics for pain : unit of measure: number |
| To investigate the frequency use of analgesics for pain | baseline, 3 months and 6 months and in case of open label treatment after 9 and 12 months | the frequency use of analgesics for pain (daily, multiple times per day, multiple times per week, monthly, when necessary) |
| Denosumab effect on average pain scores | at baseline, 3 months and after 6 months and in case of open label treatment after 9 and 12 months | Evaluation of average pain score changes after treatment, assessed by Brief Pain Inventory (scale 0 to 10; 0-no pain,10 worst pain) |
| Denosumab effect on serum bone markers | baseline, 3 months and 6 months and in case of open label treatment after 9 and 12 months | effect of denosumab on bone serum markers (alkaline phosphatase (measure unit: U/L), P1NP -Procollagen-1-propeptide (measure unit: ng/ml), Beta-crosslaps (measure unit: ug/L) |
| Denosumab effect on serum markers | baseline, 3 months and 6 months and in case of open label treatment after 9 and 12 months | effect of Denosumab on serum calcium(mmol/L), fosfate (mmol/L), PTH (pmol/L) |
| Denosumab effect on lesion size | baseline and after 6 months, and in the case of open label treatment after 12 months | Na18F-PET/CT scan- measurement of lesion size |
| Denosumab effect on lesion activity | baseline and after 6 months, and in the case of open label treatment after 12 months | Na18F-PET/CT scan- ,measurement of Na18F uptake |
| disease quantification (Skeletal Burden Score (SBS) | at baseline, 6 months and after 12 months | nuclear imaging ((Skeletal Burden Score (SBS): scale 0 to 75, higher scores meaning increased disease activity |
| Denosumab effect on bone density | baseline and after 12 months | Dual-energy X-ray absorptiometry (DXA) - bone density measurement ( T-score of -1.0 or above = normal bone density T-score between -1.0 and -2.5 = low bone density, or osteopenia; T-score of -2.5 or lower = osteoporosis) |
| Denosumab effect on vertebral fractures | baseline and after 12 months | Dual-energy X-ray absorptiometry (DXA) - assement of presence of Vertebral Fractures through Vertebral Fractures Assessment (VFA) and changes from baseline until 12 months after |
| To assess potential side effects in the form of Atypical femoral fractures | after 12 months | Dual-energy X-ray absorptiometry (DXA) femur extended |
| To investigate the dosage of analgesics used for pain | baseline, 3 months and 6 months and in case of open label treatment after 9 and 12 months | dosage of analgesics used for pain (unit of measure: mg) |
Countries
Netherlands
Contacts
Primary ContactNatasha Appelman-Dijkstra, MD, PhD
Outcome results
None listed