5 INDICATIONS

Prolia® is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, Prolia® reduces the incidence of vertebral, See More

For the treatment of postmenopausal women with osteoporosis at high risk for fracture

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Prolia® vs alendronate: see the results of a head-to-head transition BMD study

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STUDY OF ADHERENCE, PREFERENCE, AND SATISFACTION

Patient adherence, preference, and satisfaction with Prolia® vs alendronate1

In a multicenter, randomized, open-label, cross-over study1

The primary endpoint was adherence during the first year (end of treatment period 1).1

Select Secondary Endpoints include:1,2

  • Treatment adherence at the end of period 2
  • Subject preference at the end of year 2, as assessed in the validated Preference and Satisfaction Questionnaire (PSQ)
  • Proportion of subjects satisfied with treatment at the end of each treatment period as assessed in the PSQ

Study Design Limitations1

  • Consider open-label study limitations when interpreting results. This open-label study was not blinded and not controlled
  • Patients knew their adherence and BMD were being monitored, which may have influenced treatment adherence
  • Use of 1-year treatment periods limits conclusions that can be made about long-term compliance
  • Provision of medication in this study removed any influence of treatment cost on adherence
  • Adherence results measures in clinical studies are higher than in clinical practice
  • Head-to-head fracture studies have not been conducted

See more study design details

Patients who transitioned to Prolia® showed statistically significant changes in total hip and lumbar spine BMD1

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Methods1

  • Multicenter, randomized, open-label, cross-over study
  • Subjects were randomized to receive either Prolia® or alendronate for 1 year before switching treatments for year 2
  • Prolia® 60 mg was administered subcutaneously by a healthcare professional every 6 months
  • Alendronate 70 mg was taken orally once every week
  • Participants were instructed to take 1000 mg calcium and 400 IU vitamin D daily

Key Inclusion Criteria1

  • Postmenopausal women aged 55 or older with no prior bisphosphonate or denosumab treatment
  • T-score between -2.0 and -4.0 at the lumbar spine, total hip, or femoral neck

ALN = alendronate; DMAB = denosumab; PO = by mouth; Q6M = once every 6 months; QW = once a week; SC = subcutaneous.

*For subjects who wished to withdraw from treatment in period 1 prior to the month 12 visit but still remain in the study, the treatment cross-over could occur any time prior to the month 12 visit.

At both 12 and 24 months, more patients were adherent on Prolia® (vs alendronate)1

Treatment Adherence1

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12 Months

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24 Months

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Adherence was defined as a composite of being both compliant and persistent with therapy1

  • Prolia® compliance: Received 2 Prolia® injections 6 months apart (± 4 weeks)
  • Prolia® persistence: Received both injections and completed treatment within the allotted time
  • Alendronate compliance: Took 80% of once-weekly tablets
  • Alendronate persistence: Took 2 tablets in last month and completed treatment within the allotted time
  • Results suggest a treatment sequence effect (treatment-by-period interaction): Adherence rates in the alendronate group were lower after crossover from Prolia®, and rates were higher in the Prolia® group after crossover from alendronate. Transitioning from biannual to weekly administration may have been more difficult than the converse1

More patients expressed overall preference for Prolia® (vs alendronate)1,2

Preference at 24 months (patient-reported)1,2,*

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Preference

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Preference for Continued Use

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*Graph reflects the more than 93% of respondents who expressed a preference for one treatment over the other.
†p < 0.0001.

The Preference and Satisfaction Questionnaire (PSQ) is a validated instrument

  • 34-item, self-reported questionnaire assessing a patient's preferences for and satisfaction with different study treatments

Preference1

  • Patients’ preference for Prolia® was not affected by treatment sequence (before or after alendronate)
  • Patient preference was assessed through the two following questions:
    • Preference: “Which do you prefer: the weekly pill, the 6-month injection, or no preference?”
    • Preference for continued use: “If your physician says both are reasonable options for you, which would you take long term? The weekly pill, the 6-month injection, I would not choose one over the other”

More patients reported greater satisfaction with Prolia® (vs alendronate)1,2

Satisfaction at 24 months (patient-reported)1,2

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Satisfaction1,*

  • Patients reported their level of satisfaction with either Prolia® (6-month injection) or alendronate (weekly pill) on a 5-point scale (not at all, a little, moderately, quite, or very satisfied)
  • More patients reported that they were “quite” or “very” satisfied with Prolia® than alendronate (at 12 and 24 months, combined) in terms of:
    • Convenience (93% with Prolia®; 62% with alendronate)
    • Mode of administration: tablet or injection (91% with Prolia®; 69% with alendronate)
    • Frequency of administration (95% with Prolia®; 63% with alendronate)

*Satisfaction includes combined data from both groups in both periods.

Overall, a similar number of participants reported adverse events (AEs) in each treatment group (63.2% on alendronate, 65.7% on Prolia®)1,2

SUMMARY OF ADVERSE EVENTS1,2

Overall Study

Alendronate (N = 228)
n (%)		 Prolia® (denosumab) (N = 230)
n (%)
Any AE 144 (63.2) 151 (65.7)
Serious AEs 9 (3.9) 8 (3.5)
AEs of fracture* 2 (0.9) 4 (1.7)
AEs of osteoporotic fracture† 1 (0.4) 3 (1.3)
AEs 5% frequency in either treatment group
Arthralgia 15 (6.6) 14 (6.1)
Pain in extremity 9 (3.9) 14 (6.1)
Back pain 13 (5.7) 9 (3.9)

Includes only treatment-emergent adverse events occurring on or before the end of the specific treatment period.

N = number of patients who received at least 1 dose of study drug during the specific treatment period.

n = number of patients reporting at least 1 adverse event during the specific treatment period.

*On-study fractures were as follows: Prolia® — 2 foot, 1 pubis, 1 ulna; alendronate — 1 fibula, 1 humerus.

†On-study osteoporotic fractures were as follows: Prolia® — 2 foot, 1 ulna; alendronate — 1 humerus.

No deaths, osteonecrosis of the jaw, or atypical femoral fractures were reported in the study1,2

IMPORTANT SAFETY INFORMATION

SEVERE HYPOCALCEMIA IN PATIENTS WITH ADVANCED KIDNEY DISEASE:

Patients with advanced chronic kidney disease are at greater risk of severe hypocalcemia following Prolia administration. Severe hypocalcemia resulting in hospitalization, life-threatening events and fatal cases have been reported. The presence of chronic kidney disease-mineral bone disorder (CKD-MBD) markedly increases the risk of hypocalcemia. Prior to initiating Prolia in patients with advanced chronic kidney disease, evaluate for the presence of CKD-MBD. Treatment with Prolia in these patients should be supervised by a healthcare provider with expertise in the diagnosis and management of CKD-MBD.

Contraindications: Prolia® is contraindicated in patients with hypocalcemia. Pre-existing hypocalcemia must be corrected prior to initiating Prolia®. Prolia® is contraindicated in women who are pregnant and may cause fetal harm. In women of reproductive potential, pregnancy testing should be performed prior to initiating treatment with Prolia®. Prolia® is contraindicated in patients with a history of systemic hypersensitivity to any component of the product. Reactions have included anaphylaxis, facial swelling and urticaria.

Severe Hypocalcemia and Mineral Metabolism Changes: Prolia can cause severe hypocalcemia and fatal cases have been reported. Pre existing hypocalcemia must be corrected prior to initiating therapy with Prolia. Adequately supplement all patients with calcium and vitamin D.

In patients without advanced chronic kidney disease who are predisposed to hypocalcemia and disturbances of mineral metabolism (e.g. treatment with other calcium lowering drugs), assess serum calcium and mineral levels (phosphorus and magnesium) 10 to14 days after Prolia injection.

Same Active Ingredient: Prolia® contains the same active ingredient (denosumab) found in XGEVA®. Patients receiving Prolia® should not receive XGEVA®.

Hypersensitivity: Clinically significant hypersensitivity including anaphylaxis has been reported with Prolia®. Symptoms have included hypotension, dyspnea, throat tightness, facial and upper airway edema, pruritus and urticaria. If an anaphylactic or other clinically significant allergic reaction occurs, initiate appropriate therapy and discontinue further use of Prolia®.

Osteonecrosis of the Jaw (ONJ): ONJ, which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients receiving Prolia®. An oral exam should be performed by the prescriber prior to initiation of Prolia®. A dental examination with appropriate preventive dentistry is recommended prior to treatment in patients with risk factors for ONJ such as invasive dental procedures, diagnosis of cancer, concomitant therapies (e.g., chemotherapy, corticosteroids, angiogenesis inhibitors), poor oral hygiene, and co-morbid disorders. Good oral hygiene practices should be maintained during treatment with Prolia®. The risk of ONJ may increase with duration of exposure to Prolia®.

For patients requiring invasive dental procedures, clinical judgment should guide the management plan of each patient. Patients who are suspected of having or who develop ONJ should receive care by a dentist or an oral surgeon. Extensive dental surgery to treat ONJ may exacerbate the condition. Discontinuation of Prolia® should be considered based on individual benefit-risk assessment.

Atypical Femoral Fractures: Atypical low-energy, or low trauma fractures of the shaft have been reported in patients receiving Prolia®. Causality has not been established as these fractures also occur in osteoporotic patients who have not been treated with antiresorptive agents.

During Prolia® treatment, patients should be advised to report new or unusual thigh, hip, or groin pain. Any patient who presents with thigh or groin pain should be evaluated to rule out an incomplete femur fracture. Interruption of Prolia® therapy should be considered, pending a risk/benefit assessment, on an individual basis.

Multiple Vertebral Fractures (MVF) Following Discontinuation of Prolia® Treatment: Following discontinuation of Prolia® treatment, fracture risk increases, including the risk of multiple vertebral fractures. New vertebral fractures occurred as early as 7 months (on average 19 months) after the last dose of Prolia®. Prior vertebral fracture was a predictor of multiple vertebral fractures after Prolia® discontinuation. Evaluate an individual’s benefit/risk before initiating treatment with Prolia®. If Prolia® treatment is discontinued, consider transitioning to an alternative antiresorptive therapy.

Serious Infections: In a clinical trial (N=7808), serious infections leading to hospitalization were reported more frequently in the Prolia® group than in the placebo group. Serious skin infections, as well as infections of the abdomen, urinary tract and ear were more frequent in patients treated with Prolia®.

Endocarditis was also reported more frequently in Prolia®-treated patients. The incidence of opportunistic infections and the overall incidence of infections were similar between the treatment groups. Advise patients to seek prompt medical attention if they develop signs or symptoms of severe infection, including cellulitis.

Patients on concomitant immunosuppressant agents or with impaired immune systems may be at increased risk for serious infections. In patients who develop serious infections while on Prolia®, prescribers should assess the need for continued Prolia® therapy.

Dermatologic Adverse Reactions: In the same clinical trial in women with postmenopausal osteoporosis, epidermal and dermal adverse events such as dermatitis, eczema and rashes occurred at a significantly higher rate with Prolia® compared to placebo. Most of these events were not specific to the injection site. Consider discontinuing Prolia® if severe symptoms develop.

Musculoskeletal Pain: Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking Prolia®. Consider discontinuing use if severe symptoms develop.

Suppression of Bone Turnover: Prolia® resulted in significant suppression of bone remodeling as evidenced by markers of bone turnover and bone histomorphometry. The significance of these findings and the effect of long-term treatment are unknown. Monitor patients for consequences, including ONJ, atypical fractures, and delayed fracture healing.

Adverse Reactions: The most common adverse reactions (>5% and more common than placebo) in women with postmenopausal osteoporosis are back pain, pain in extremity, musculoskeletal pain, hypercholesterolemia, and cystitis. The most common adverse reactions (>5% and more common than placebo) in men with osteoporosis are back pain, arthralgia, and nasopharyngitis. Pancreatitis has been reported with Prolia®.

In women with postmenopausal osteoporosis, the overall incidence of new malignancies was 4.3% in the placebo group and 4.8% in the Prolia® group. In men with osteoporosis, new malignancies were reported in no patients in the placebo group and 4 (3.3%) patients in the Prolia® group. A causal relationship to drug exposure has not been established.

The most common adverse reactions (>3% and more common than active-control group) in patients with glucocorticoid-induced osteoporosis are back pain, hypertension, bronchitis, and headache.

The most common (per patient incidence 10%) adverse reactions reported with Prolia® in patients with bone loss receiving ADT for prostate cancer or adjuvant AI therapy for breast cancer are arthralgia and back pain. Pain in extremity and musculoskeletal pain have also been reported in clinical trials. Additionally, in Prolia®-treated men with nonmetastatic prostate cancer receiving ADT, a greater incidence of cataracts was observed.

Denosumab is a human monoclonal antibody. As with all therapeutic proteins, there is potential for immunogenicity.

Please see Prolia® full Prescribing Information, including Medication Guide.

IMPORTANT SAFETY INFORMATION
SEVERE HYPOCALCEMIA IN PATIENTS WITH ADVANCED KIDNEY DISEASE: Patients with advanced chronic kidney disease are at greater risk of severe hypocalcemia following Prolia administration. Severe hypocalcemia resulting in hospitalization, life-threatening events and fatal cases have been reported. The presence of chronic kidney disease-mineral bone disorder (CKD-MBD) markedly increases the risk of hypocalcemia. Prior to initiating
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References: 1. Freemantle N, Satram-Hoang S, Tang ET, et al. Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study: a 24-month, randomized, crossover comparison with alendronate in postmenopausal women. Osteoporos Int. 2012;23:317-326. 2. Data on file, Amgen. 2011.