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Autosomal Dominant Hypocalcemia OR Primary Hypoparathyroidism Related to Other Cause But Complicated by Hypercalciuria Under TreatmentPhase 2ACTICASNCT02824718

Recombinant Human rhPTH(1-34) VS Association Alfacalcidol/Hydrochlorothiazide in Severe Primary Hypoparathyroidism

A Phase 2 study testing Teriparatide, Thiazide and Potassium sparing diuretic in people with Autosomal Dominant Hypocalcemia OR Primary Hypoparathyroidism Related to Other Cause But Complicated by Hypercalciuria Under Treatment, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Hypoparathyroidism is a rare condition in which the parathyroid glands fail to produce sufficient amount of parathyroid hormone or the parathyroid hormone produced lacks biologic activity. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
Teriparatide, Thiazide and Potassium sparing diuretic
Could I receive a placebo?
No, everyone receives an active treatment
How many people
16 participants
Where
1 siteFrance
Study dates
6 Jun 2017to 28 May 2020
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients aged from 18 to 80 years, of both sexes
  • Patient with primary hypoparathyroidism related to a genetically proven ADH OR primary hypoparathyroidism related to other cause but complicated by hypercalciuria under treatment
  • Affiliated to a French health insurance system, and who have consented to the study.

Who cannot join

  • Pregnant and breastfeeding women;
  • Women of childbearing age without contraception;
  • For men aged from 18 to 20 years, presence of cartilage of growth on X-ray of left knee;
  • Anuria;
  • Kidney failure with plasmatic creatinine >125 mmol/l and urea >10 mmol/l;
  • Long QT interval : QTc > 450 ms (men) or 470 ms (women);
Show all 24Show fewer
  • Hepatic failure;
  • Metabolic bone diseases (Paget's disease of bone) other than primary osteoporosis or glucocorticoid-induced osteoporosis;
  • Association to other potassium sparing diuretics;
  • Hypokalemia (<3.5 mmol/l) without diuretic therapy;
  • Hyperkalemia (>5.5 mmol/l);
  • Hyponatremia (<135 mmol/l) without diuretic therapy;
  • Hypercalcemia (>2.6 mmol/l);
  • Severe hypomagnesemia (≤ 0.5 mmol/l);
  • Vitamin D deficiency (25OH vit D < 20 ng/mL);
  • Unexplained increase in alkaline phosphatase (>2N);
  • Intolerance to sulfamide;
  • Intolerance to amiloride or other component of the drug;
  • Hypersensitivity to any active substance or excipient of one of the experimental drugs;
  • Gluten intolerance;
  • Bone break history within the three previous months;
  • History of radiotherapy of the skeleton;
  • History of bone cancer or metastasis.
  • Personnal or familial (first degree relatives) of skin cancer

Trial locations and contacts

1 site in 1 country.

France1 site
  • AP-HP Hopital Europeen Georges Pompidou

    Paris, 75015

Other trials in France

About this study

Official title: A Randomized Crossover TrIal to Compare Recombinant Human rhPTH(1-34) to the ASsociation Alfacalcidol/Hydrochlorothiazide in the Treatment of Severe Primary Hypoparathyroidism

Hypoparathyroidism is a rare condition in which the parathyroid glands fail to produce sufficient amount of parathyroid hormone or the parathyroid hormone produced lacks biologic activity. The most common cause of hypoparathyroidism is damage to or removal of the parathyroid glands due to neck surgery for another condition. Occurrence of hypercalciuria under treatment is a frequent concern in primary hypoparathyroidism, limiting correction of hypocalcemia.

Hypoparathyroidism can also be caused by an autoimmune process. In rare cases, hypoparathyroidism may occur as a genetic disorder inherited as an autosomal recessive, autosomal dominant or X-linked recessive trait. The autosomal dominant hypocalcemia (ADH) is mainly caused by heterozygous activating mutations in the CASR gene encoding CaSR). As other severe presentation of primary hypothyroidism, ADH is characterized by the increased risk to develop hypercalciuria and nephrolithiasis. The purpose of the study is to compare two therapeutic approaches in severe hypoparathyroidism in order to limit the risk of nephrocalcinosis and renal failure when attempting to correct hypocalcemia: rhPTH(1-34) vs association of active vitamin D and hydrochlorothiazide. The European Society of Endocrinology Clinical has indeed recently published guidelines for the treatment of chronic hypoparathyroidism in adults. These guidelines suggest considering treatment with a thiazide diuretic In a patient with hypercalciuria and replacement therapy with PTH in patients who do not stably and safely maintain their serum and urinary calcium in the target range.

Read the detailed description

The design consists in a five-periods, two-treatments, open-label, randomized, crossover study with blind end-point evaluation.

Patients will come for an inclusion visit and will receive treatment with 0.5 µg/day alfacalcidol for 4 weeks (28±3 days, run-in). They will be instructed to maintain dietary calcium intakes (1 g/day) for the duration of the study and will be supplemented throughout the study with native vitamin D in order to maintain the concentration of 25OH vitamin D ≥ 40 ng/L. Magnesium supplementation (100 mg/day) will be maintained throughout the study.

At inclusion, patients will be randomly assigned to receive at the end of run-in period, in cross-over either an association hydrochlorothiazide 25 mg/day (ESIDREX®) + amiloride 5 mg/day (MODAMIDE®) + 0.5 µg/day alfacalcidol (ALFACALCIDOL®) or 40 µg/day rhPTH(1-34) (teriparatide or FORSTEO® 20 µg twice daily) over 7 to 8 weeks (52±3 days).

After a washout period of 28±3 days under 0.5 µg alfacalcidol /day, the patients will follow the second period of treatment. The study will end with a final period of 28±3 days under 0.5 µg alfacalcidol /day. Patients will ambulatory monitor serum calcium, sodium, potassium, and creatinine levels at days 15 of run in and run out periods and at day 7 and day 28 of each treatment period.

Being tested
Teriparatide, Thiazide, Potassium sparing diuretic, Alfacalcidol
Keywords
Hypoparathyroidism, PTH(1-34), Thiazides, Hypercalciuria, Calcium sensing receptor
Medical subject headings
Hypoparathyroidism, Hypercalciuria

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TeriparatideDrug

    Also called FORSTEO

    human recombinant parathormone

  • ThiazideDrug

    Also called ESIDREX

    Diuretic

  • Potassium sparing diureticDrug

    Also called MODAMIDE

    Diuretic

  • AlfacalcidolDrug

    Also called UN-ALFA

    Belongs to the class of vitamin D and analogues

Study groups in NCT02824718
Study groupRoleWhat they receive
rh PTH(1-34)Experimental40 µg/day rhPTH(1-34) (teriparatide or FORSTEO® 20 µg twice daily) over 7 to 8 weeks (52±3 days).
Receives: Drug: Teriparatide
Thiazide + potassium sparing diureticActive comparatorhydrochlorothiazide 25 mg/day (ESIDREX®) + amiloride 5 mg/day (MODAMIDE®) + 0.5 µg/day alfacalcidol (ALFACALCIDOL®) over 7 to 8 weeks (52±3 days).
Receives: Drug: Thiazide; Drug: Potassium sparing diuretic; Drug: Alfacalcidol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Plasma calcium concentration

    Mean of two measures at 30-min interval of Ionized serum calcium concentration

    Measured: two months of treatment

Secondary outcomes (25)
  1. Ambulatory calcium concentration

    Ambulatory measurement of serum calcium level

    Measured: days 7 an 28 of treatment by rhPTH(1-34) and association alfacalcidol/hydrochlorothiazide and at day 14 of non-treatment periods (run in, wash out, run out).

  2. Calciuria

    24h-urinary calcium excretion (expressed as mmol/24h and mmol/mmol creatinine)

    Measured: Inclusion, weeks 4 (end of the run-in period), 7-8 (end of the first treatment period), 11-12 (end of the wash-out period), 18-20 (end of the second treatment period), 202 (end of the wash-out period)

  3. Plasma calcium x phosphate product

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  4. Blood pressure

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  5. Serum sodium level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  6. Serum potassium level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  7. Estimated GFR using MDRD formula

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  8. Serum renin level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  9. Serum aldosterone level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  10. 24h-urinary sodium excretion

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  11. 24h-urinary potassium excretion

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  12. 24h-urinary aldosterone excretion

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  13. Serum 25 OH vitamin D level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  14. Serum 1,25(OH)2 vitamin D level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  15. Serum magnesium level

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  16. 24h-urinary magnesium excretion

    Tolerance of thiazides and amiloride

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  17. Calcium/citrate ratio measured on spot urines

    Assessment of stone formation risk

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  18. Calcium/creatinine ratios measured on spot urines

    Assessment of stone formation risk

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  19. Crystalluria

    Assessment of stone formation risk

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  20. Alkaline phosphatase level

    Evaluation of the impact of rhPTH(1-34) on bone

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  21. Number of episodes of cramps

    Other tolerance

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  22. Number of episodes of paresthesia

    Other tolerance

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  23. Number of episodes of tetany

    Other tolerance

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  24. Number of episodes of seizure

    Other tolerance

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

  25. SF36 self-administered questionnaire

    Evaluation of the impact on quality of life

    Measured: Inclusion, days 28 (end of the run-in period), 80 (end of the first treatment period), 108 (end of the wash-out period), 160 (end of the second treatment period), 202 (end of the wash-out period)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jul 2016 (estimated)
  2. Study start6 Jun 2017
  3. Primary completion28 May 2020
  4. Study completion28 May 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
16 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02824718
Sponsor's protocol ID
P150911
Other IDs
PHRC-15-549, 2016-000500-29, 2016
Acronym
ACTICAS
Status last verified
Jun 2021
First submitted
1 Jul 2016
Last updated
28 Jun 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Teriparatide, Thiazide and Potassium sparing diuretic in people with Autosomal Dominant Hypocalcemia OR Primary Hypoparathyroidism Related to Other Cause But Complicated by Hypercalciuria Under Treatment, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Jun 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Plasma calcium concentration (time frame: two months of treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jun 2021.

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