title: Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Alendronate Once-Weekly Study Group.
abstract: Dosing convenience is a key element in the effective management of any chronic disease, and is particularly important in the long-term management of osteoporosis. Less frequent dosing with any medication may enhance compliance, thereby maximizing the effectiveness of therapy. Animal data support the rationale that once-weekly dosing with alendronate 70 mg (7 times the daily oral treatment dose) could provide similar efficacy to daily dosing with alendronate 10 mg due to its long duration of effect in bone. In addition, dog studies suggest that the potential for esophageal irritation, observed with daily oral bisphosphonates, may be substantially reduced with once-weekly dosing. This dosing regimen would provide patients with increased convenience and would be likely to enhance patient compliance. We compared the efficacy and safety of treatment with oral once-weekly alendronate 70 mg (N=519), twice-weekly alendronate 35 mg (N=369), and daily alendronate 10 mg (N=370) in a one-year, double-blind, multicenter study of postmenopausal women (ages 42 to 95) with osteoporosis (bone mineral density [BMD] of either lumbar spine or femoral neck at least 2.5 SDs below peak premenopausal mean, or prior vertebral or hip fracture). The primary efficacy endpoint was the comparability of increases in lumbar spine BMD, using strict pre-defined equivalence criteria. Secondary endpoints included changes in BMD at the hip and total body and rate of bone turnover, as assessed by biochemical markers. Both of the new regimens fully satisfied the equivalence criteria relative to daily therapy. Mean increases in lumbar spine BMD at 12 months were: 5.1% (95% CI 4.8, 5.4) in the 70 mg once-weekly group, 5.2% (4.9, 5.6) in the 35 mg twice-weekly group, and 5.4% (5.0, 5.8) in the 10 mg daily treatment group. Increases in BMD at the total hip, femoral neck, trochanter, and total body were similar for the three dosing regimens. All three treatment groups similarly reduced biochemical markers of bone resorption (urinary N-telopeptides of type I collagen) and bone formation (serum bone-specific alkaline phosphatase) into the middle of the premenopausal reference range. All treatment regimens were well tolerated with a similar incidence of upper GI adverse experiences. There were fewer serious upper GI adverse experiences and a trend toward a lower incidence of esophageal events in the once-weekly dosing group compared to the daily dosing group. These data are consistent with preclinical animal models, and suggest that once-weekly dosing has the potential for improved upper GI tolerability. Clinical fractures, captured as adverse experiences, were similar among the groups. We conclude that the alendronate 70 mg once-weekly dosing regimen will provide patients with a more convenient, therapeutically equivalent alternative to daily dosing, and may enhance compliance and long-term persistence with therapy.
authors.forename: T
authors.initials: T
authors.lastname: Schnitzer
authors.forename: H G
authors.initials: HG
authors.lastname: Bone
authors.forename: G
authors.initials: G
authors.lastname: Crepaldi
authors.forename: S
authors.initials: S
authors.lastname: Adami
authors.forename: M
authors.initials: M
authors.lastname: McClung
authors.forename: D
authors.initials: D
authors.lastname: Kiel
authors.forename: D
authors.initials: D
authors.lastname: Felsenberg
authors.forename: R R
authors.initials: RR
authors.lastname: Recker
authors.forename: R P
authors.initials: RP
authors.lastname: Tonino
authors.forename: C
authors.initials: C
authors.lastname: Roux
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
authors.forename: A J
authors.initials: AJ
authors.lastname: Foldes
authors.forename: S L
authors.initials: SL
authors.lastname: Greenspan
authors.forename: M A
authors.initials: MA
authors.lastname: Levine
authors.forename: R
authors.initials: R
authors.lastname: Emkey
authors.forename: A C
authors.initials: AC
authors.lastname: Santora
authors.forename: A
authors.initials: A
authors.lastname: Kaur
authors.forename: D E
authors.initials: DE
authors.lastname: Thompson
authors.forename: J
authors.initials: J
authors.lastname: Yates
authors.forename: J J
authors.initials: JJ
authors.lastname: Orloff
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005272:Femur Neck / Q000378:metabolism; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D008161:Lumbosacral Region; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000378:metabolism; D013131:Spine / Q000378:metabolism; D013810:Therapeutic Equivalency
chemical_list: D019386:Alendronate