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Teriparatide

Phase 4FDA approved

Femur Neck Fracture | Small molecule | Musculoskeletal |Eli Lilly and Company|Trials Updated: May 12, 2023

Teriparatide development status

FDA approval on record Nov 26, 2002 as Forteo
Approval holderLilly
ApplicationNDA021318
Highest phase Phase 4 (NCT01360424)
Phase scored for LLYPhase 3
Registered trials 58 across 22 sponsors since May 2002

Label indication FORTEO is indicated: For the treatment of postmenopausal women with osteoporosis at high risk for fracture (defined herein as having a history of osteoporotic fracture or multiple risk factors for fracture) or who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, FORTEO reduces the risk of vertebral and nonvertebral fractures. FDA label

Teriparatide target and mechanism

Molecular targetPTH1R
Target classAgonist
ModalitySmall molecule

Also known as Subcutaneous Teriparatide, Teriparatide (PTH 1-34), Group 1, Forteo, Forsteo, LY333334

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLEDDMC
Total Trials22
Total Enrollment5,088

FDA Designations

No designations recorded

Teriparatide clinical trials

Teriparatide · 22 trials · 13 indications

Phase 3 14Phase 2 6Phase 1 2
NCT01473589Effect of Teriparatide on Hip Fracture HealingFemur Neck Fracture
COMPLETED122 Analytics
NCT01473602Second Study of the Effect of Teriparatide on Hip Fracture HealingFemur Neck Fracture
COMPLETED39 Analytics
NCT00577863Study of the Experience of Patients With Osteoporosis Using the Forteo B Pen to Self Administer Once Daily Teriparatide TherapyOsteoporosis
COMPLETED200 Analytics
NCT00503399Comparison of the Effects of 2 Drugs on Lumbar Spine Volumetric BMD in Men With Glucocorticoid-Induced OsteoporosisOsteoporosis
COMPLETED92 Analytics
NCT00433160Phase 3 Clinical Trial of Teriparatide in JapanOsteoporosis
COMPLETED207 Analytics
NCT00414973A Study for Patients With OsteoporosisOsteoporosis
COMPLETED364 Analytics
NCT00343252Effect of Teriparatide Compared to Risedronate on Back Pain in Women With a Spine Fracture Caused by OsteoporosisOsteoporosis, Postmenopausal
COMPLETED712 Analytics
NCT00191321Teriparatide Use in Hip Replaced SubjectsOsteoporosis
COMPLETED60 Analytics
NCT00532207Study of Teriparatide in the Treatment of Postmenopausal Women With OsteoporosisOsteoporosis, Post-Menopausal
COMPLETED50 Analytics
NCT00191893Bone Effects of Teriparatide Following AlendronateOsteoporosis
COMPLETED66 Analytics
PHASE3COMPLETED
Effect of Teriparatide on Hip Fracture Healing
Femur Neck FractureUnlock trial analytics
PHASE3COMPLETED
Second Study of the Effect of Teriparatide on Hip Fracture Healing
Femur Neck FractureUnlock trial analytics
PHASE3COMPLETED
Study of the Experience of Patients With Osteoporosis Using the Forteo B Pen to Self Administer Once Daily Teriparatide Therapy
OsteoporosisUnlock trial analytics
PHASE3COMPLETED
Comparison of the Effects of 2 Drugs on Lumbar Spine Volumetric BMD in Men With Glucocorticoid-Induced Osteoporosis
OsteoporosisUnlock trial analytics
PHASE3COMPLETED
Phase 3 Clinical Trial of Teriparatide in Japan
OsteoporosisUnlock trial analytics
PHASE3COMPLETED
A Study for Patients With Osteoporosis
OsteoporosisUnlock trial analytics
PHASE3COMPLETED
Effect of Teriparatide Compared to Risedronate on Back Pain in Women With a Spine Fracture Caused by Osteoporosis
Osteoporosis, PostmenopausalUnlock trial analytics
PHASE3COMPLETED
Teriparatide Use in Hip Replaced Subjects
OsteoporosisUnlock trial analytics
PHASE3COMPLETED
Study of Teriparatide in the Treatment of Postmenopausal Women With Osteoporosis
Osteoporosis, Post-MenopausalUnlock trial analytics
PHASE3COMPLETED
Bone Effects of Teriparatide Following Alendronate
OsteoporosisUnlock trial analytics

Study Endpoints

Primary Endpoints

Percentage of Participants With No Revision Surgery at 12 Months After Internal Fixation of a Low-Trauma Femoral Neck Fracture
12 months

Revision surgery (re-operation) was defined as any additional surgical intervention performed or recommended at the site of the index procedure, except those that were planned at the time of the index procedure.

Summary of Forteo B Pen Complaints at 8 Weeks
8 weeks

Summary of number of complaints, and common complaints (at least 3% complaint rate), from subjects using Forteo B Pen. Functional Complaints were related to device malfunction; Nonfunctional were related to either cosmetic or perception concerns.

Number of Subjects With Forteo B Pen Complaints at 8 Weeks
8 weeks

Number of subjects with complaints after 8 weeks, and common complaints (at least 3% complaint rate), using Forteo B Pen. Functional Complaints were related to device malfunction; Nonfunctional were related to either cosmetic or perception concerns.

Summary of Forteo B Pen Complaints at 46 Weeks
46 weeks

Summary of number of complaints, and common complaints (at least 3% complaint rate), from subjects using Forteo B Pen. Functional Complaints were related to device malfunction; Nonfunctional were related to either cosmetic or perception concerns.

Number of Subjects With Forteo B Pen Complaints at 46 Weeks
46 weeks

Number of subjects with complaints after 46 weeks, and common complaints (at least 3% complaint rate), using Forteo B Pen. Functional Complaints were related to device malfunction; Nonfunctional were related to either cosmetic or perception concerns.

Change From Baseline in Lumbar Spine Volumetric Trabecular Bone Mineral Density (BMD) by Quantitative Computerized Tomography (QCT) at 18 Months
Baseline, 18 months

Least Squares (LS) Means were adjusted for age, baseline serum aminoterminal propeptide of Type I procollagen (P1NP), fracture less than 12 months before study start, duration of prior bisphosphonate use, screening glucocorticoid dose, and cumulative glucocorticoid dose before and during the trial.

Percent Change in Bone Mineral Density at Lumbar Spine (L2-L4)
Baseline to 52 weeks

Percent change in bone mineral density (BMD) at lumbar spine (L2-L4) from baseline to the last measurement point.

Percentage Change From Baseline to 24 Week Endpoint in Lumbar Spine Bone Mineral Density (BMD), Postmenopausal Women
Baseline to 24 weeks

Lumbar spine bone mineral density (milligrams per square centimeter) was measured by dual energy X-ray absorptiometry (DXA). Change = Endpoint minus baseline.

Number of Participants Responding With at Least a 30% Reduction in 24-Hour Worst Back Pain Severity at the 6-Month Endpoint
6 Months

24-hour worst back pain severity scores recorded daily on an 11-point numeric rating scale, an ordinal scale ranging from 0 (no pain) to 10 (worst possible pain). The 11-point scale is used for assessment of worst back pain in the preceding 24 hours and is evaluated daily in the week prior to each scheduled study visit. Responders are defined as participants with at least a 30% reduction in the severity of worst back pain from baseline to the 6-month last observation carried forward (LOCF) endpoint.

Effect of Teriparatide (20 mcg/day for 18 months ) on bone turnover markers: CTx, PINP and BSAP
To test the hypothesis that therapy for 12 months with once daily subcutaneous PTH 1-34 (teriparatide; TPTD) 20 micrograms will increase Bone Mineral Density (BMD) at the lumbar spine in postmenopausal women with osteoporosis
conventional histomorphometric parameters (bone turnover, bone formation rate, and bone volume) and microdamage accumulation from iliac crest biopsies.
The primary objective is to determine the acceptance of, and compliance with, 6 months of teriparatide subcutaneous injections in patients with severe osteoporosis who have failed on OR are intolerant to currently available osteoporosis therapies.
Change From Baseline at 18 Month Endpoint in Lumbar Spine Bone Mineral Density (BMD)
18 month endpoint

change from baseline at endpoint in bone mineral density of the lumbar spine as assessed by dual energy X-ray absorptiometry (DXA)

To demonstrate a reduction in the proportion of patients with new vertebral fractures (by spinal x-ray) following 3-year treatment with 20 and 40 micrograms/day of LY333334 plus calcium and vitamin D compared with calcium and vitamin D alone.
Baseline, randomization, 24 , 36, and 60 months
Change in Lumbar Spine Bone Density by Dual Energy X-ray Absorptiometry (DXA)
Baseline, Month 18 or 24 reported

Areal BMD at the lumbar spine was measured by dual energy x-ray absorptiometry (DXA) at baseline and at 6, 12, 18, and 24 months, if possible.

Change from baseline to endpoint 96 days in procollagen 1 N-terminal propeptide (P1NP)
Baseline, 96 days
Knee MRI
Change from Baseline through study completion (baseline, 24 weeks, 48 weeks), an average of one year.

Analysis using Regional Cartilage Volume Segmentation

Percent Change From Baseline in Lumbar Spine Bone Mineral Density (BMD) at 12 Months
Baseline, 12 Months

Bone mineral density (BMD) of the lumbar spine was assessed by dual energy X-ray absorptiometry (DXA). BMD values are corrected data and have been standardized across the machine types (Hologic and Lunar). Analyses were performed using ANCOVA model and least square (LS) means were adjusted for baseline BMD values as a covariate and pooled site and treatment as fixed effects.

To assess the dose response of LY333334 with the percent change from baseline in lumbar spine mineral density at endpoint
Time to radiographic healing
The primary objective of this pilot study is to determine the effect of Forteo (PTH) on periodontal regeneration.
Part A - Cumulative Skin Irritation by Draize Score
Day 1 through Day 22

Number of evaluation points (patches) showing defined Draize score. Erythema and edema were used to determine skin irritation. Score 0 = No Erythema/Edema; Score 1 = Very slight Erythema/Edema (barely perceptible); Score 2 = Well defined Erythema/Edema (edges of area well defined by definite raising); Score 3 = Moderate to Severe Erythema/Edema (raised approximately 1 millimeter \[mm\]).

Part B - Skin Irritation and Sensitization by Draize Score
Days 1 - 19 and 34 - 37

Number of evaluation points (patches) showing defined Draize score. Erythema and edema were used to determine skin irritation and sensitization. Score 0 = No Erythema/Edema; Score 1 = Very slight Erythema/Edema (barely perceptible); Score 2 = Well defined Erythema/Edema (edges of area well defined by definite raising); Score 3 = Moderate to Severe Erythema/Edema (raised approximately 1 mm); Score 4 = Severe Edema (raised more than 1 mm and extending beyond area of exposure).

Secondary Endpoints

Percentage of Participants With Radiographic Evidence of Healing
Randomization up to 12 months
Percentage of Participants With Pain Control During Ambulation
Up to 12 months
Percentage of Participants Without Severe Fracture-Site Pain During 24 Hours Prior to Visit
Up to 12 months
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Study Design & Arms

AllocationRANDOMIZED
MaskingTRIPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
PlaceboPLACEBO_COMPARATORAdministered once daily by subcutaneous (SC) injection for 6 months
TeriparatideEXPERIMENTAL20 microgram (µg) administered once daily by SC injection for 6 months
RisedronateACTIVE_COMPARATORRisedronate 35 milligrams (mg) oral (po) tablet once weekly (QW)
AEXPERIMENTAL -
BACTIVE_COMPARATOR -
1EXPERIMENTALLY333334 40 micrograms/day plus calcium and vitamin D
2EXPERIMENTALLY333334 20 micrograms/day plus calcium and vitamin D
3PLACEBO_COMPARATORPlacebo plus calcium and vitamin D
Women with Idiopathic osteoporosis (IOP)EXPERIMENTALEach subject will receive 20 micrograms of Teriparatide (PTH 1-34) subcutaneously daily for 18 -24 months
50 mcgEXPERIMENTALViaDerm transdermal delivery
80 mcgEXPERIMENTALAdd Via-Derm transdermal delivery
20 mcgACTIVE_COMPARATORSubcutaneous injection
Group 1- TreatmentACTIVE_COMPARATOR20 mcg dosage amounts of teriparatide, in the FDA approved form Forteo, manufactured by Lilly, LLC, are loaded into a 2.4 ml prefilled delivery device (multi injection pen) that administers 28 equal doses as subcutaneous injections in the thigh or abdominal wall. Subjects will inject themselves once a day for 24 weeks.
Group 2- PlaceboPLACEBO_COMPARATORSaline placebo is packaged by the manufacturer (Lilly, LLC) in the same 2.4 ml injection pen that is used for teriparatide; it will provide 28 doses of placebo. Subjects will inject themselves once a day for 24 weeks.
20 mcg Subcutaneous TeriparatideACTIVE_COMPARATORReceived 20 micrograms (mcg) subcutaneously once daily in an unblinded manner.
30 mcg Transdermal TeriparatideEXPERIMENTALReceived 30 micrograms (mcg) teriparatide transdermally via a patch applied once daily. Participants were blinded to dose level.
50 mcg Transdermal TeriparatideEXPERIMENTALReceived 50 micrograms (mcg) teriparatide transdermally via a patch applied once daily. Participants were blinded to dose level.
80 mcg Transdermal TeriparatideEXPERIMENTALReceived 80 micrograms (mcg) teriparatide transdermally via a patch applied once daily. Participants were blinded to dose level.
FORTEOEXPERIMENTAL -
LY333334 + placeboEXPERIMENTALPart A: Both a placebo and an 80 microgram active patch will be applied to the same arm for at least 6 hours daily, test arms will be alternated daily, for 22 days Part B: Induction phase: Both a placebo and an 80 microgram active patch will be applied to the same arm for at least 6 hours daily, test arms will be alternated daily, 4 times a week for 3 weeks Rest phase: 2 weeks with no patch application Challenge phase: 80 microgram active patch given once for at least 6 hours

Interventions

NameTypeDescription
TeriparatideDRUGAdministered by SC injection
PlaceboDRUGAdministered by SC injection
Calcium supplementationDIETARY_SUPPLEMENTAdministered orally
Vitamin D supplementationDIETARY_SUPPLEMENTAdministered orally
RisedronateDRUG35 mg/week po for 18 months
Salmon CalcitoninDRUGIntranasal, 200 International Units (IU)/day, 24 weeks
Alendronate SodiumDRUG10 mg/day, oral, 36 months
Calcium SupplementDRUGApproximately 1000 mg/day of elemental calcium will be supplied as open-label oral supplement
Vitamin D SupplementDRUGApproximately 400 to 1200 IU/day of vitamin D will be supplied as open-label oral supplement
raloxifeneDRUG -
Teriparatide (PTH 1-34)DRUG20 micrograms subcutaneous injection daily
Subcutaneous TeriparatideDRUGAdministered subcutaneously once daily for 12 months
Transdermal TeriparatideDRUGAdministered transdermally, applied once daily for 6 hours over 12 months
Periodontal surgeryPROCEDURE -
FORTEODRUGparathyroid hormone; self-administration for 6 weeks
Vitamin D and CalciumDIETARY_SUPPLEMENTPO, QD, for six weeks
LY333334DRUGTransdermal patch
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Eligibility Criteria

Age Range50 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites92

Inclusion Criteria: * Community dwelling men and postmenopausal women who were ambulatory before sustaining a low-trauma, unilateral femoral neck fracture (displaced or nondisplaced) * Other than femoral neck fracture, be free of incapacitating conditions and have a life expectancy of at least 2 ye...

Countries:United StatesAustraliaCanadaDenmarkEstoniaFinlandHong KongIndiaIsraelJapanLatviaLithuaniaNew ZealandNorwayPuerto RicoSouth KoreaSpainSwedenTaiwanBelgiumCroatiaFranceGermanyGreeceHungaryNetherlandsPolandRomaniaSwitzerlandTurkey (Türkiye)ItalyChinaArgentinaBrazilMexicoRussiaAustriaCzechiaUnited Kingdom
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Frequently asked questions about Teriparatide

What is Teriparatide?

Teriparatide is a small molecule drug developed by Eli Lilly and Company (ticker LLY) that is being studied in clinical trials for musculoskeletal conditions. Its research indications include osteoporosis, post-menopausal osteoporosis, femur neck fracture, Colles' fracture, and knee osteoarthritis. It is also known as subcutaneous Teriparatide or Teriparatide (PTH 1-34).

What does Teriparatide target?

Teriparatide targets the parathyroid hormone 1 receptor (PTH1R) and acts as an agonist. By binding to and activating PTH1R, it mimics the action of parathyroid hormone, which regulates calcium and bone metabolism. This mechanism underlies its investigation in bone healing and osteoporosis.

Who makes Teriparatide?

Teriparatide is developed by Eli Lilly and Company, which trades under the ticker symbol LLY. Eli Lilly is the sponsor responsible for the clinical development program of Teriparatide across its studied indications.

What phase is Teriparatide in?

Teriparatide is in Phase 2 clinical development. It is an investigational drug and has not been approved by the FDA for the indications currently being studied. The development program includes both Phase 2 and Phase 3 trials, with 11 total trials reported and 10 completed.

What clinical trials is Teriparatide in?

Teriparatide has been studied in several clinical trials, including NCT03072147, a Phase 2 trial of Teriparatide as a chondroregenerative therapy in knee osteoarthritis; NCT01473602 and NCT01473589, Phase 3 trials evaluating its effect on hip fracture healing in femur neck fracture; and NCT01011556, a Phase 2 transdermal application study in osteoporosis.

Is Teriparatide the same as subcutaneous Teriparatide or Teriparatide (PTH 1-34)?

Yes, Teriparatide is also known as subcutaneous Teriparatide and Teriparatide (PTH 1-34). These alternative names refer to the same drug developed by Eli Lilly and Company. The designation PTH 1-34 reflects the active fragment of parathyroid hormone used in the molecule.