Denosumab, which was approved in the United States in 2010, is a fully
human sequence IgG2 monoclonal antibody that inhibits bone resorption
by blocking the activity of receptor activator of nuclear factor-κB ligand
(RANKL). RANKL is a TNF family protein that is expressed in both
secreted and cell surface forms by a variety of bone marrow cell types
andmediates bone resorption through its receptor (RANK),which is found
on osteoclasts and osteoclast precursors . Denosumab was discovered
using XenomouseTM transgenic mice comprising human immunoglobulin
genes. The antibody is approved for treatment of postmenopausal
women with osteoporosis at high risk for fracture, and for the prevention of
skeletal-related events in patients with bone metastases from solid tumors.
Denosumab competes directly with bisphosphonates such as alendronic
acid in postmenopausal osteoporosis and with zoledronic acid in both of
these indications. It has been shown to have comparable efficacy and safety
to bisphosphonates with some tolerability and patient acceptability advantages.
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Prevention and treatment of all forms of osteoporosis or bone loss.
Indications
Prevention of skeletal-related events (e.g., bone pain and fractures) secondary to multiple myeloma or bone metastases from solid tumors. Used in conjunction with treatments for primary malignancy.
Giant cell tumor of the bone. Indicated in adults and skeletally mature adolescents with an unresectable tumor or when surgical resection would likely cause severe morbidity.
Hypercalcemia of malignancy. This drug is indicated when hypercalcemia is refractory to bisphosphonate therapy.
Osteoporosis. Indicated as therapy for postmenopausal women with osteoporosis at high risk for fracture. Indications also include the treatment of men with osteoporosis at high risk of fracture. A high risk for fracture is defined as those with multiple risk factors for fracture, a known history of an osteoporotic fracture, or those who have failed prior osteoporosis treatment (e.g., bisphosphonates).
Glucocorticoid-induced osteoporosis. Indicated for treatment in patients of both sexes at high risk for fracture who are initiating or continuing systemic glucocorticoids at a dose greater than or equal to 7.5 mg of prednisone daily for an expected duration of at least six months.
Bone loss. Indicated for treating androgen deprivation-induced bone loss and aromatase inhibitor-induced bone loss. The goal of therapy is to increase bone mass in men with prostate cancer receiving androgen deprivation therapy. In women, the treatment goal is to increase bone mass when receiving aromatase inhibitor therapy for breast cancer.
