This is a randomized, double-blind, placebo- and active-controlled Phase II study evaluating the efficacy and safety of TST002 injection (a humanized monoclonal antibody) in postmenopausal women with osteoporosis or low bone mass, aged 45-80 years. Approximately 110 participants will be randomized 1:1:1:1:1 (stratified by baseline BMD T-score) to one of five arms: TST002 400 mg every 8 weeks (Q8W), TST002 800 mg Q8W, TST002 1200 mg every 12 weeks (Q12W), placebo, or open-label denosumab 60 mg subcutaneously every 24 weeks. The study includes a screening period (Day -28 to Day -1), a main study period (Week 0-24), and an extension period (Week 25-52), with all participants followed through Week 52 (Day 365). The primary objective is to evaluate the effect of repeated IV TST002 infusions on lumbar spine bone mineral density (BMD). Secondary objectives include characterization of pharmacokinetics, pharmacodynamics, immunogenicity, safety, and tolerability.
Primary Purpose: Efficacy and safety evaluation of TST002 in postmenopausal osteoporosis and low bone mass. Design: 5-arm, randomized, double-blind (denosumab arm open-label), placebo- and active-comparator (denosumab)-controlled, parallel-group study with stratified block randomization by screening BMD T-score (Stratum 1: T-score ≥ -2.00; Stratum 2: T-score \< -2.00 at all sites). Enrollment capped at \<20% Stratum 1 participants per arm. All participants receive daily calcium (600-1200 mg elemental) and vitamin D (725-1450 IU) supplementation from screening through study end, with an optional vitamin D loading dose for those with baseline 25(OH)D 20-40 ng/mL. Unblinding: Primary analysis after all participants complete Week 24 is performed by an unblinded CRO team; investigators, participants, and the CRO study team (except for the open-label denosumab arm) remain blinded until final study unblinding
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
110
Percent change from baseline in lumbar spine Bone Mineral Density (BMD)
Lumbar spine (L1-L4) bone mineral density, central imaging read (DXA)
Time frame: Baseline to Week 24
Percent change from baseline in lumbar spine Bone Mineral Density (BMD)
Central imaging read (DXA)
Time frame: Weeks 12 and 52
Percent change from baseline in total hip Bone Mineral Density (BMD)
Central imaging read (DXA)
Time frame: Weeks 12, 24, and 52
Percent change from baseline in femoral neck Bone Mineral Density (BMD)
Central imaging DXA
Time frame: Weeks 12, 24 and 52
TST002 plasma concentration
Plasma concentrations at each dosing timepoint
Time frame: Up to 52 weeks
Percent change from baseline in bone turnover markers
P1NP, β-CTX, OC, BSAP, TRACP-5b, and total sclerostin
Time frame: Up to 52 weeks
Anti-drug antibody (ADA) positivity rate
Immunogenicity - proportion positive and time to first positive
Time frame: Up to 52 weeks
Incidence of adverse events
AEs, vital signs, physical exam, and clinically significant lab abnormalities (CTCAE v6.0 graded)
Time frame: Up to 52 weeks
TST002 Concentration-time
Area under curve (AUC)
Time frame: Up to 52 weeks
TST002 Peak Plasma Concentration
Cmax
Time frame: Up to 52 weeks
TST002 Trough Concentrations
Ctrough
Time frame: Up to 52 weeks
TST002 Half-life
T1/2
Time frame: Up to 52 weeks
TST002 Systemic Clearance
CL
Time frame: Up to 52 weeks
TST002 Volume of Distribution
Vd
Time frame: Out to 52 weeks
TST002 Effects on total Sclerostin
Pharmacodynamic effects
Time frame: Up to 52 weeks
TST002 Effects on total P1NP
Pharmacodynamic effects of Serum N-terminal propeptide of procollagen type 1
Time frame: Up to 52 weeks
TST002 Effects on total B-CTX
Pharmacodynamic effects of Beta-C-terminal telopeptide
Time frame: Out to 52 weeks
TST002 Effects on total OC
Pharmacodynamic effects of osteocalcin
Time frame: Out to 52 weeks
TST002 Effects on total BSAP
Pharmacodynamic effects of Bone-specific alkaline phosphatase
Time frame: Up to 52 weeks
TST002 Effects on total TRACP-5b
Pharmacodynamic effects of Tartrate-Resistant Acid Phosphatase 5b
Time frame: Up to 52 weeks
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