"March 7, 2013 -- An FDA panel voted to stop recommending calcitonin salmon for the treatment of osteoporosis in women who are at least five years past menopause.
The committee voted 12-9 against continued marketing of the drug, citing"...
Clinical Trials Experience
Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The data described below reflect exposure to EVISTA (raloxifene) in 3385 patients, including 2250 exposed for 1 year and 1972 for at least 3 years.
Osteoporosis Treatment Clinical Trial — The safety of raloxifene in the treatment of osteoporosis was assessed in a large (7705 patients) multinational, placebo-controlled trial. Duration of treatment was 36 months, and 5129 postmenopausal women were exposed to raloxifene (2557 received 60 mg/day, and 2572 received 120 mg/day). The incidence of all-cause mortality was similar between groups: 23 (0.9%) placebo, 13 (0.5%) EVISTA-treated (raloxifene 60 mg), and 28 (1.1%) raloxifene 120 mg women died. Therapy was discontinued due to an adverse reaction in 10.9% of EVISTA (raloxifene) -treated women and 8.8% of placebo-treated women.
Venous Thromboembolism: The most serious adverse reaction related to EVISTA (raloxifene) was VTE (deep venous thrombosis, pulmonary embolism, and retinal vein thrombosis). During an average of study-drug exposure of 2.6 years, VTE occurred in about 1 out of 100 patients treated with EVISTA (raloxifene) . Twenty-six EVISTA (raloxifene) -treated women had a VTE compared to 11 placebo-treated women, the hazard ratio was 2.4 (95% confidence interval, 1.2, 4.5), and the highest VTE risk was during the initial months of treatment.
Common adverse reactions considered to be related to EVISTA (raloxifene) therapy were hot flashes and leg cramps. Hot flashes occurred in about one in 10 patients on EVISTA (raloxifene) and were most commonly reported during the first 6 months of treatment and were not different from placebo thereafter. Leg cramps occurred in about one in 14 patients on EVISTA (raloxifene) .
Placebo-Controlled Osteoporosis Prevention Clinical Trials — The safety of raloxifene has been assessed primarily in 12 Phase 2 and Phase 3 studies with placebo, estrogen, and estrogen-progestin therapy control groups. The duration of treatment ranged from 2 to 30 months, and 2036 women were exposed to raloxifene (371 patients received 10 to 50 mg/day, 828 received 60 mg/day, and 837 received from 120 to 600 mg/day).
Therapy was discontinued due to an adverse reaction in 11.4% of 581 EVISTA (raloxifene) -treated women and 12.2% of 584 placebo-treated women. Discontinuation rates due to hot flashes did not differ significantly between EVISTA (raloxifene) and placebo groups (1.7% and 2.2%, respectively).
Common adverse reactions considered to be drug-related were hot flashes and leg cramps. Hot flashes occurred in about one in four patients on EVISTA (raloxifene) versus about one in six on placebo. The first occurrence of hot flashes was most commonly reported during the first 6 months of treatment.
Table 1 lists adverse reactions occurring in either the osteoporosis treatment or in five prevention placebo- controlled clinical trials at a frequency ≥ 2.0% in either group and in more EVISTA (raloxifene) -treated women than in placebo- treated women. Adverse reactions are shown without attribution of causality. The majority of adverse reactions occurring during the studies were mild and generally did not require discontinuation of therapy.
Table 1: Adverse Reactions Occurring in Placebo-Controlled Osteoporosis Clinical Trials at a Frequency ≥ 2.0% and in more EVISTA (raloxifene) -Treated (60 mg Once Daily) Women than Placebo-Treated Womena
| EVISTA (raloxifene)
| EVISTA (raloxifene)
|Body as a Whole|
|Metabolic and Nutritional|
|Skin and Appendages|
|Urinary Tract Infection||A||A||4.0||3.9|
|Urinary Tract Disorder||2.5||2.1||A||A|
| a A: Placebo incidence greater than or equal to
EVISTA (raloxifene) incidence; B: Less than 2% incidence and more frequentwith EVISTA (raloxifene) .
b Includes only patients with an intact uterus: Prevention Trials: EVISTA (raloxifene) , n=354, Placebo, n=364; Treatment Trial:EVISTA (raloxifene) , n=1948, Placebo, n=1999.
c Actual terms most frequently referred to endometrial fluid.
Comparison of EVISTA (raloxifene) and Hormone Therapy — EVISTA (raloxifene) was compared with estrogen-progestin therapy in three clinical trials for prevention of osteoporosis. Table 2 shows adverse reactions occurring more frequently in one treatment group and at an incidence ≥ 2.0% in any group. Adverse reactions are shown without attribution of causality.
Table 2: Adverse Reactions Reported in the Clinical Trials for Osteoporosis Prevention with EVISTA (raloxifene) (60 mg Once Daily) and Continuous Combined or Cyclic Estrogen Plus Progestin (Hormone Therapy) at an Incidence ≥ 2.0% in any Treatment Groupa
| EVISTA (raloxifene)
| Hormone Therapy
| Hormone Therapy-Cyclicd
|Body as a Whole|
| a These data are from both blinded and open-label studies.
b Includes only patients with an intact uterus: EVISTA (raloxifene) , n=290; Hormone Therapy-Continuous Combined, n=67;Hormone Therapy-Cyclic, n=217.
c Continuous Combined Hormone Therapy = 0.625 mg conjugated estrogens plus 2.5 mg medroxyprogesteroneacetate.
d Cyclic Hormone Therapy = 0.625 mg conjugated estrogens for 28 days with concomitant 5 mgmedroxyprogesterone acetate or 0.15 mg norgestrel on Days 1 through 14 or 17 through 28.
Breast Pain — Across all placebo-controlled trials, EVISTA (raloxifene) was indistinguishable from placebo with regard to frequency and severity of breast pain and tenderness. EVISTA (raloxifene) was associated with less breast pain and tenderness than reported by women receiving estrogens with or without added progestin.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Read the Evista (raloxifene) Side Effects Center for a complete guide to possible side effects
Concomitant administration of cholestyramine with EVISTA (raloxifene) is not recommended. Although not specifically studied, it is anticipated that other anion exchange resins would have a similar effect. EVISTA (raloxifene) should not be co- administered with other anion exchange resins [see CLINICAL PHARMACOLOGY].
If EVISTA (raloxifene) is given concomitantly with warfarin or other coumarin derivatives, prothrombin time should be monitored more closely when starting or stopping therapy with EVISTA [see CLINICAL PHARMACOLOGY].
Other Highly Protein-Bound Drugs
EVISTA (raloxifene) should be used with caution with certain other highly protein-bound drugs such as diazepam, diazoxide, and lidocaine. Although not examined, EVISTA (raloxifene) might affect the protein binding of other drugs. Raloxifene is more than 95% bound to plasma proteins [see CLINICAL PHARMACOLOGY].
The safety of concomitant use of EVISTA (raloxifene) with systemic estrogens has not been established and its use is not recommended.
Other Concomitant Medications
EVISTA (raloxifene) can be concomitantly administered with ampicillin, amoxicillin, antacids, corticosteroids, and digoxin [see CLINICAL PHARMACOLOGY].
The concomitant use of EVISTA (raloxifene) and lipid-lowering agents has not been studied.
Read the Evista Drug Interactions Center for a complete guide to possible interactions
Last reviewed on RxList: 9/26/2007
This monograph has been modified to include the generic and brand name in many instances.
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