Role of the Melanocortin-4 Receptor in Hypoactive Sexual Desire Disorder

This is an interventional treatment trial for Hypoactive Sexual Desire Disorder focused on measuring Hypoactive Sexual Desire Disorder, Bremelanotide, Functional MRI, Melanocortin-4 receptor Read More

Inclusion Criteria:

• Heterosexual premenopausal females ≥ 18 years of age with normal menstrual cycles ≤ 35 days.
• Right hand dominant.
• Body mass index (BMI) 18-35kg/m2.
• Currently in a relationship with a male partner and the relationship has been stable for at least 6 months before screening.
• Male sexual partner classified as "not impotent" on the Massachusetts Male Aging Study (MMAS) single-question assessment of erectile dysfunction.
• In the subject's opinion, previously experienced "normal sexual function," defined as a normal level of desire at some point in the past, for a period of at least 2 years.
• For all subjects of childbearing potential who are sexually active, agree to routinely use adequate non-hormonal contraception from randomisation throughout the duration of the study and for 30 days after.
• For at least 6 months before Screening, met the diagnostic criteria for HSDD according to the Diagnostic Screening Guide for HSDD, including categorisation of the sexual dysfunction as both acquired (versus lifelong) and generalised (versus situational).

• All of the following at Screening:

  1. Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001) total score is <10.
  2. PHQ-9 score for Question 9 is 0.
  1. Either Female Sexual Function Index (FSFI) total score ≤26 if diagnosed with HSDD (with or without symptoms of decreased arousal) or subjects diagnosed with HSDD only (without symptoms of decreased arousal), FSFI desire domain score of ≤5 (regardless of total FSFI score).
  2. Female Sexual Distress Scale - Desire/Arousal/Orgasm (FSDS-DAO) total score is >18.
• Capable of understanding and complying with the protocol requirements and available for the duration of the study.
• Subjects must have prior experience in viewing sexually explicit material.

Exclusion Criteria:

• Cardiovascular disease

• Current diagnosis of uncontrolled hypertension defined as:

  1. Two sequential assessments (seated, approximately 4 minutes apart and no more than 15 minutes apart) with readings above 140 mmHg systolic BP or 90 mmHg diastolic BP, and upon repeat at least 24 hours later.
  2. Treatment for hypertension that has been changed at least once in the 4 weeks prior to Screening.
• Any other medical condition that is unstable or uncontrolled despite current therapy.
• Previously received Bremelanotide.
• A history of unresolved sexual trauma or abuse.
• Female subjects who are pregnant, intend to become pregnant, are breastfeeding, have a positive serum/urine pregnancy test, or are not willing to use effective contraceptive precautions during the study.
• Participated in any research study within the preceding 30 days of screening.
• Any FSD other than acquired HSDD with or without decreased arousal (e.g. lifelong anorgasmia, sexual pain disorder, sexual aversion disorder, primary female sexual arousal disorder).
• FSD caused by untreated endocrine disease (e.g. hypopituitarism, hypothyroidism, diabetes mellitus).
• Acute or chronic hepatitis.
• In the Investigator's opinion, any urologic or gynecologic condition, such as condyloma, uterine fibroids, vulvar or vaginal lesions, vulvodynia, vaginismus, or pelvic pain that may contribute to impaired sexual activity and function or be a cause of the FSD or that may interfere with the subject's ability to comply with study procedures.
• Receiving any treatment for HSDD (e.g. psychotherapy, physical therapy) at the time of Screening.

• Has used any of the following types of medications, which are prohibited during the study:

  1. Implanted or injected testosterone product within 6 months of Screening.
  2. Within 3 months of Screening:
• Neuroleptics (e.g. risperidone)
• Lithium (e.g. lithium carbonate)
• Antidepressants (e.g. amitriptyline, fluoxetine, bupropion)
• Mood stabilisers (e.g. valproate)
• Benzodiazepines (e.g. lorazepam, diazepam)
• Cognitive enhancers or stimulants (e.g. donepezil or Adderall®)
• Centrally-acting antihypertensives (e.g. clonidine)
• Any other prescription, non-prescription, hormonal, herbal, or nutritional medication or supplement that the investigators believe would confound the results of the study (e.g. St. John's wort, black cohosh, dehydroepiandrosterone, dehydroepiandrosterone sulfate)
• γ-Aminobutyric acid agonists (e.g. Ambien® [zolpidem], Lunesta® [eszopiclone]) c. Topical or systemic androgen therapy within 30 days of Screening. d. Subject is unwilling or unable to refrain from using the aforementioned products for the duration of the study.

• Mental health history that includes any of the following:

  1. Psychosis, bipolar disorder, depression, and/or alcohol/substance abuse; depression or alcohol/substance abuse that resolved >1 year prior to Screening/Visit 1 will not be exclusionary.
  2. Prior suicide attempt or increased suicidality as indicated by a score greater than zero on Questions 1-5 inclusive (interpreted increased risk) and/or Question 20 (interpreted history of suicide) of the Beck Scale for Suicidal Ideation (BSS),
• Any abnormality in vision that would impair viewing images.
• Any contraindication to MRI or otherwise unable to undergo an MRI (e.g. pacemaker, recent wound clips, severe claustrophobia, unable to lay flat).
• Any other condition or subject responsibility that in the Investigator's opinion may interfere with a subject's ability to give informed consent or adhere to the protocol or has the potential to interfere with the studied endpoints or serves as a contraindication to the subject's participation in the study.