C-Type Natriuretic Peptide Analogue Therapy in Children with Achondroplasia

N Engl J Med. 2019 Jul 4;381(1):25-35. doi: 10.1056/NEJMoa1813446. Epub 2019 Jun 18.


Background: Achondroplasia is a genetic disorder that inhibits endochondral ossification, resulting in disproportionate short stature and clinically significant medical complications. Vosoritide is a biologic analogue of C-type natriuretic peptide, a potent stimulator of endochondral ossification.

Methods: In a multinational, phase 2, dose-finding study and extension study, we evaluated the safety and side-effect profile of vosoritide in children (5 to 14 years of age) with achondroplasia. A total of 35 children were enrolled in four sequential cohorts to receive vosoritide at a once-daily subcutaneous dose of 2.5 μg per kilogram of body weight (8 patients in cohort 1), 7.5 μg per kilogram (8 patients in cohort 2), 15.0 μg per kilogram (10 patients in cohort 3), or 30.0 μg per kilogram (9 patients in cohort 4). After 6 months, the dose in cohort 1 was increased to 7.5 μg per kilogram and then to 15.0 μg per kilogram, and in cohort 2, the dose was increased to 15.0 μg per kilogram; the patients in cohorts 3 and 4 continued to receive their initial doses. At the time of data cutoff, the 24-month dose-finding study had been completed, and 30 patients had been enrolled in an ongoing long-term extension study; the median duration of follow-up across both studies was 42 months.

Results: During the treatment periods in the dose-finding and extension studies, adverse events occurred in 35 of 35 patients (100%), and serious adverse events occurred in 4 of 35 patients (11%). Therapy was discontinued in 6 patients (in 1 because of an adverse event). During the first 6 months of treatment, a dose-dependent increase in the annualized growth velocity was observed with vosoritide up to a dose of 15.0 μg per kilogram, and a sustained increase in the annualized growth velocity was observed at doses of 15.0 and 30.0 μg per kilogram for up to 42 months.

Conclusions: In children with achondroplasia, once-daily subcutaneous administration of vosoritide was associated with a side-effect profile that appeared generally mild. Treatment resulted in a sustained increase in the annualized growth velocity for up to 42 months. (Funded by BioMarin Pharmaceutical; ClinicalTrials.gov numbers, NCT01603095, NCT02055157, and NCT02724228.).

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Achondroplasia / drug therapy*
  • Achondroplasia / physiopathology
  • Adolescent
  • Biomarkers / analysis
  • Body Height / drug effects
  • Child
  • Child, Preschool
  • Collagen / blood
  • Cyclic GMP / urine
  • Dose-Response Relationship, Drug
  • Female
  • Growth / drug effects*
  • Growth Charts
  • Humans
  • Injections, Subcutaneous
  • Male
  • Natriuretic Peptide, C-Type / administration & dosage
  • Natriuretic Peptide, C-Type / adverse effects
  • Natriuretic Peptide, C-Type / analogs & derivatives*
  • Natriuretic Peptide, C-Type / therapeutic use
  • Osteogenesis / drug effects*


  • Biomarkers
  • Natriuretic Peptide, C-Type
  • vosoritide
  • Collagen
  • Cyclic GMP

Associated data

  • ClinicalTrials.gov/NCT01603095
  • ClinicalTrials.gov/NCT02055157
  • ClinicalTrials.gov/NCT02724228