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PHARMA - CALCIUM OSTEOPOROSIS THERAPY

P&G’s Actonel with Calcium approved for osteoporosis

 

BY OUR PHARMA CORRESPONDENT

18th August,2005: The US drug regulator has granted approval for Procter & Gamble’s Actonel with Calcium (risedronate sodium tablets with calcium carbonate tablets, USP).

Actonel with Calcium is the first prescription osteoporosis therapy to include calcium to provides fracture protection.

Actonel with Calcium is a prescription therapy indicated for the prevention and treatment of postmenopausal osteoporosis. Actonel with Calcium includes four weeks of therapy. Each week contains seven tablets (one 35 mg once-a-week Actonel tablet and six tablets that each provide 500 mg calcium). This new treatment option comes in light of the recent Surgeon General's Report on Bone Health and Osteoporosis which emphasizes the need for osteoporosis regimens to be simplified and organized.

"Calcium is a critical component to the effectiveness of osteoporosis therapy," said Steven Goldstein, MD, Professor of Obstetrics and Gynecology, at the New York University School of Medicine. "Actonel with Calcium is an important new tool that helps simplify the osteoporosis regimen by conveniently delivering two important elements -- the bisphosphonate and the calcium -- in one unique package."

Calcium is a basic building block of bone and is essential for maintaining bone health. Despite this, two new surveys suggest that many women may not take enough calcium or may take it incorrectly with a bisphosphonate therapy like Actonel. According to a study conducted by Information Resources, Inc. (IRI), 73 percent of women who filled a bisphosphonate prescription purchased less than the equivalent of one calcium tablet per day. A second survey conducted by Harris Interactive revealed that one in four U.S. women aged 50 and over (26 percent) take calcium within 30 minutes of their bisphosphonate, which decreases the effectiveness of the bisphosphonate. Both surveys were conducted on behalf of The Alliance for Better Bone Health.

"Many women need to understand the importance of how to follow a proper daily calcium regimen to realize the full effectiveness of an osteoporosis regimen that includes a bisphosphonate," said Goldstein. "The Actonel with Calcium packaging system offers women a new way to take their Actonel and their calcium correctly and consistently," a Procter and Gamble release said. 

When the body does not get enough calcium, it breaks down bone to help meet its calcium needs. According to the Surgeon General's Report on Bone Health and Osteoporosis, the average adult intake of calcium is approximately 700 mg daily, which is below the U.S. recommended daily allowance (RDA) of 1200 mg for women over 50. Many women who are taking a bisphosphonate may be able to make up this difference by taking a 500 mg calcium tablet, which is the amount of calcium found in Actonel with Calcium (risedronate sodium tablets with calcium carbonate tablets, USP).

The release also lists suggestions for taking calcium

* Women aged 50 years and older should get a total of at least 1200 mg of calcium through dietary intake and, if necessary, a calcium supplement.

* Calcium, whether from diet or supplements, is absorbed best by the body when it is taken in doses of 500 mg or less of elemental calcium at one time.

* Calcium should not be taken at the same time as a bisphosphonate; bisphosphonate effectiveness decreases if calcium is taken within 30 minutes.

* Women should talk with their doctors about the bone health regimen that's right for them.

Actonel with Calcium is contraindicated in patients with known hypersensitivity to any component of this product, or inability to stand or sit upright for at least 30 minutes. Actonel (risedronate sodium tablets) and Calcium are contraindicated, respectively, in patients with hypocalcemia and hypercalcemia. These and other disturbances of bone and mineral metabolism should be effectively treated before starting Actonel with Calcium therapy. Actonel with Calcium is not recommended for use in patients with severe renal impairment (creatinine clearance < 30 mL/min). In patients with conditions causing or predisposing to hypercalcemia and in patients with a history of kidney stones, the administration of calcium should be assessed prior to prescribing and then monitored appropriately.

Bisphosphonates may cause upper gastrointestinal disorders such as dysphagia, esophagitis and esophageal or gastric ulcer. Patients should pay particular attention to the dosing instructions, as failure to take the drug according to instructions may compromise clinical benefits and may increase the risk of adverse events. Calcium may cause gastrointestinal adverse effects such as constipation, flatulence, nausea, abdominal pain, and bloating.

Among patients treated with bisphosphonates, there have been infrequent reports of severe and occasionally incapacitating bone, joint and/or muscle pain. Rare occurrences of osteonecrosis, primarily of the jaw (ONJ), have been reported in patients receiving bisphosphonates. Most ONJ cases have occurred in cancer patients undergoing dental procedures. In the majority of cases reported, patients had received intravenous bisphosphonate therapy.

In clinical trials, Actonel was generally well tolerated. The overall incidence of adverse events with Actonel 5 mg daily was comparable to placebo. The most commonly reported adverse events regardless of causality were infection (primarily upper respiratory, placebo 29.7% vs Actonel 5 mg 29.9%), back pain (23.6% vs 26.1%), and arthralgia (21.1% vs 23.7%).

In a 1-year clinical trial comparing Actonel 35 mg Once-a-Week and Actonel 5 mg daily, the overall incidence of adverse events with the two dosing regimens was similar. The most commonly reported adverse events regardless of causality were infection (Actonel 35 mg 20.6% vs Actonel 5 mg 19.0%), arthralgia (14.2% vs 11.5%) and constipation (12.2% vs 12.5%). 

Osteoporosis is a silent disease that affects millions of postmenopausal women, making their bones weak and more likely to fracture over time. In fact, in the U.S. today, 8 million women are estimated to already have osteoporosis, and almost 27 million more are estimated to have low bone mass, placing them at increased risk for fracture. Each year the incidence of osteoporosis-related fractures is greater than the incidence of heart attacks, strokes, and breast cancer combined. The good news is that there are prescription medications available that effectively reduce both vertebral and nonvertebral fracture risk.

Actonel with Calcium is marketed by The Alliance for Better Bone Health, a collaboration between Procter & Gamble Pharmaceuticals and Aventis Pharmaceuticals, now a member of the sanofi-aventis Group. Actonel with Calcium works by slowing or stopping the cells that cause bone loss.

Harris Interactive, the 15th largest market research firm in the world, is a Rochester, NY-based global research company conducted the online and telephone survey between February 9 and 18, 2005 on behalf of The Alliance for Better Bone Health among 1,004 U.S. women aged 50 and over, of which 372 were bisphosphonate users. Data were weighted to be representative of the total U.S. adult female population aged 50 and over on the basis of age, race/ethnicity, education, region, income and propensity to be online. Though the online sample is not a probability sample, with probability samples of this size, Harris Interactive estimates with 95 percent certainty that the overall results have a sampling error of plus or minus 3 percentage points. Sampling error for the various sub-sample results, including bisphosphonate users (372); bisphosphonate users who also take calcium supplements (338); and calcium supplement users (755), is higher and varies.

This study conducted by Information Resources, Inc. (IRI) analyzed calcium purchasing practices of current bisphosphonate users over a one-year period. 498 households of women who filled a prescription for a bisphosphonate one year prior to and at least once during the current 52-week period were included in this study. Households were part of Ire’s Repulse Patient Panel, a subset of Ire’s Consumer Network Panel, a nationally representative set of 70,000 households that scan all of their bar-coded purchases at home. Households within the Repulse Patient Panel used scanning devices to record prescription information, including name of drug, strength and dose frequency, for each individual in their households. Data for supplement purchases included brand, calcium content (mg) and total tablet count.

The panel provided a single source of data for bisphosphonate usage as well as total number of calcium supplement tablets (including Tums) purchased. Panel data are weighted to match U.S. demographics, and aggregate claimed purchases are verified through a comparison to store level scanner data. For this study, the supplement category was specifically examined and confirmed to fit within standard limits.

Procter & Gamble Company has one of the strongest portfolios of consumer oriented products including Pampers, Tide, Ariel, Always, Whisper, Pantene, Bounty, Pringles, Folgers, Charmin, Downy, Lenor, Iams, Crest, Actonel, Olay and Clairol Nice 'n Easy, Head & Shoulders, and Wella. The P&G community consists of almost 110,000 employees working in over 80 countries worldwide. 

BY OUR PHARMA CORRESPONDENT

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