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Teriparatide improved outcomes of periodontal surgery
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ASBMR Annual Meeting
TORONTO — Short-term teriparatide administration for 6 weeks was associated with improved clinical and radiographic outcomes during the year of observation after periodontal surgery, a new study found.
Results of the small study showed that patients taking teriparatide therapy experienced significantly greater radiographic linear resolution of osseous defects at 6 months, compared with placebo. The mean linear bone gain in the teriparatide group was 29% at 1 year as compared with 3% in the placebo group (P<.001).
“The use of a systemic anabolic agent like teriparatide provides an exciting new avenue of therapeutic potential,” Jill D. Bashutski, DDS, and colleagues at the University of Michigan said at the American Society of Bone and Mineral Research 2010 Annual Meeting. The study was simultaneously published in the New England Journal of Medicine.
The double-masked, placebo-controlled study included 40 patients with severe, chronic periodontitis who underwent periodontal surgery. Patients were assigned to daily injections of teriparatide 20 mcg or placebo for 6 weeks, as well as oral calcium 1,000 mg and vitamin D 800 IU.
Improved outcomes in the short term
Teriparatide therapy was also associated with a reduction in periodontal probing depth of 33% vs. 20% (2.42 mm vs. 1.32 mm) and a gain in clinical attachment level of 22% vs. 7% (1.58 mm vs. 0.42 mm) in target lesions at 1 year (P=.02 for both).
No serious adverse events were reported.
Teriparatide is composed of the first 34 amino acids of parathyroid hormone. It is known to have anabolic effects on bone. The drug has been evaluated for its effects on the treatment of osteoporosis and fractures, however, clinical trials for the treatment of osseous conditions of the oval cavity were previously lacking. Treatment with teriparatide is currently limited to 2 years because data have suggested that long-term exposure may be associated with increased risk for osteosarcoma.
The data suggest that “a short dosing regimen may have long-lasting effects,” the researchers wrote in the study. “Similarly, gains in clinical attachment levels continued to be seen throughout the course of the study in the teriparatide group, whereas the maximum gain occurred at 3 months in the placebo group.”
Questions remain
According to Andrew Grey, MD, of the department of medicine at University of Auckland, New Zealand, results of this small, preliminary study suggested that teriparatide “might confer additional benefit over that achieved with standard care in patients with severe periodontitis.”
However, Grey wrote, many questions remain, including: “How durable is the effect of teriparatide? What is the optimal dosing regimen? Does teriparatide alter important end points such as tooth loss or the need for further operative intervention? Do antiresorptive agents, which cost considerably less than teriparatide, confer similar benefits?” Grey recommended larger, longer-term trials that compare different regimens to answer these questions.
For more information:
- Bashutski JD. Concurrent oral session 03: Disorders of bone and mineral metabolism – metabolic bone disease. #1018. Presented at: American Society of Bone and Mineral Research; Oct. 15-19, 2010; Toronto.
- Bashutski JD. N Engl J Med. 2010;doi:10.1056/NEJMoa1005361.
- Grey A. N Engl J Med. 2010;doi:10.1056/NEJMe1010459.
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