Randomized trial of the anti-FGF23 antibody KRN23 in X-linked hypophosphatemia
Thomas O. Carpenter, … , Karl L. Insogna, Munro Peacock
Thomas O. Carpenter, … , Karl L. Insogna, Munro Peacock
Published February 24, 2014
Citation Information: J Clin Invest. 2014;124(4):1587-1597. https://doi.org/10.1172/JCI72829.
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Clinical Medicine Clinical trials

Randomized trial of the anti-FGF23 antibody KRN23 in X-linked hypophosphatemia

Abstract

Background. X-linked hypophosphatemia (XLH) is the most common heritable form of rickets and osteomalacia. XLH-associated mutations in phosphate-regulating endopeptidase (PHEX) result in elevated serum FGF23, decreased renal phosphate reabsorption, and low serum concentrations of phosphate (inorganic phosphorus, Pi) and 1,25-dihydroxyvitamin D [1,25(OH)2D]. KRN23 is a human anti-FGF23 antibody developed as a potential treatment for XLH. Here, we have assessed the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and immunogenicity of KRN23 following a single i.v. or s.c. dose of KRN23 in adults with XLH.

Methods. Thirty-eight XLH patients were randomized to receive a single dose of KRN23 (0.003–0.3 mg/kg i.v. or 0.1–1 mg/kg s.c.) or placebo. PK, PD, immunogenicity, safety, and tolerability were assessed for up to 50 days.

Results. KRN23 significantly increased the maximum renal tubular threshold for phosphate reabsorption (TmP/GFR), serum Pi, and 1,25(OH)2D compared with that of placebo (P < 0.01). The maximum serum Pi concentration occurred later following s.c. dosing (8–15 days) compared with that seen with i.v. dosing (0.5–4 days). The effect duration was dose related and persisted longer in patients who received s.c. administration. Changes from baseline in TmP/GFR, serum Pi, and serum 1,25(OH)2D correlated with serum KRN23 concentrations. The mean t1/2 of KRN23 was 8–12 days after i.v. administration and 13–19 days after s.c. administration. Patients did not exhibit increased nephrocalcinosis or develop hypercalciuria, hypercalcemia, anti-KRN23 antibodies, or elevated serum parathyroid hormone (PTH) or creatinine.

Conclusion. KRN23 increased TmP/GFR, serum Pi, and serum 1,25(OH)2D. The positive effect of KR23 on serum Pi and its favorable safety profile suggest utility for KRN23 in XLH patients.

Trial registration. Clinicaltrials.gov NCT00830674.

Funding. Kyowa Hakko Kirin Pharma, Inc.

Authors

Thomas O. Carpenter, Erik A. Imel, Mary D. Ruppe, Thomas J. Weber, Mark A. Klausner, Margaret M. Wooddell, Tetsuyoshi Kawakami, Takahiro Ito, Xiaoping Zhang, Jeffrey Humphrey, Karl L. Insogna, Munro Peacock

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Figure 3

Effect of i.v. and s.c administration of KRN23 on serum calcium and 24-hour urine calcium compared with placebo.

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Effect of i.v. and s.c administration of KRN23 on serum calcium and 24-h...
(A and B) Serum calcium; (C and D) 24-hour urine calcium. For i.v. cohorts, six profiles are shown for panels A and C: placebo (gray), 0.003 (yellow), 0.01 (red), 0.03 (green), 0.1 (blue), and 0.3 mg/kg (black). For s.c. cohorts, five profiles are shown in panels B and D: placebo (gray), 0.1 (blue), 0.3 (black), 0.6 (pink), and 1 mg/kg (brown). Data are presented as the mean ± SEM.