Calcitonin exposure- dose and duration of included Randomized Controlled Trials
The shortest nasal spray trial treatment duration included in the meta-analysis was study
2402, which had a 6 month treatment period. Thirteen trials had a 24 month treatment period,
5 had a 36 month treatment period, and 1 trial (CT320) had a 60 month treatment period.
Daily calcitonin nasal spray treatment doses ranged from 50 IU daily to 400 IU daily and
most trials included multiple calcitonin treatment arms, with each arm evaluating a different
calcitonin dose. Only 6 trials evaluated a single dose of calcitonin. In addition to a daily
dosing schedule, trial SMCO514 included a 200 IU three times weekly arm. Besides
calcitonin, use of calcitonin plus calcium was utilized for trials SMCO503 through
SMCO511. In trial MIA-16, in addition to the calcitonin salmon and placebo groups, patients
were randomized to two additional arms: nandrolone or nandrolone plus placebo. Nandrolone
is an anabolic steroid that was being investigated for use in osteoporosis treatment. Data from
the nandrolone exposed groups were not included in the analysis.
The oral trials utilized a dose and duration of 0.8 mg once daily for 36 months (A2303) or
0.8mg twice daily for 24 months (C2301, C2302).
Assessment of malignancy in the included Randomized Controlled Trials
For both the oral and nasal spray trials, malignancy was captured as an adverse event and
was not a pre-specified safety endpoint for any of the included studies. The method of
malignancy assessment was similar across all trials, consisting of periodic reporting at patient
visits and via physical exams. The study reports submitted to the FDA do not document the
exact adverse event reporting procedures used (e.g. were all events reported, or just those
judged to be attributable to calcitonin treatment?) Additionally, there was no adjudication of
malignancies.