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Androgen Blockade and Progesterone Augmentation of Gonadotropin Secretion (CRM010)

Primary Purpose

PCOS, Polycystic Ovary Syndrome

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Micronized progesterone
Placebo
Flutamide
Estradiol patch
Sponsored by
University of Virginia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for PCOS focused on measuring PCOS, Polycystic Ovary Syndrome

Eligibility Criteria

18 Years - 30 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  • Post-pubertal (> 4 years post-menarche) adult woman aged 18-30 years
  • PCOS, defined as clinical and/or laboratory evidence of hyperandrogenism (hirsutism and/or elevated serum [calculated] free testosterone concentration) plus ovulatory dysfunction (irregular menses, fewer than 9 per year), but without evidence for other potential causes of hyperandrogenism and/or ovulatory dysfunction
  • General good health (excepting overweight, obesity, hyperandrogenism, PCOS, and adequately-treated hypothyroidism)
  • Capable of and willing to provide informed consent
  • Willing to strictly avoid pregnancy with use of reliable non-hormonal methods during the study period

Exclusion Criteria:

  • Inability/incapacity to provide informed consent
  • Males will be excluded (PCOS is unique to females)
  • Age < 18 years or > 30 years (ovarian reserve may decrease beyond age 30)
  • Obesity resulting from a well-defined endocrinopathy or genetic syndrome
  • Positive pregnancy test or current lactation
  • Evidence for non-physiologic or non-PCOS causes of hyperandrogenism and/or anovulation
  • Evidence of virilization (e.g., rapidly progressive hirsutism, deepening of the voice, clitoromegaly)
  • Total testosterone > 150 ng/dl, which suggests the possibility of virilizing ovarian or adrenal tumor
  • DHEA-S elevation > 1.5 times the upper reference range limit. Mild elevations may be seen in PCOS, and will be accepted in these groups
  • Early morning 17-hydroxyprogesterone > 200 ng/dl measured in the follicular phase, which suggests the possibility of congenital adrenal hyperplasia (if elevated during the luteal phase, the 17-hydroxyprogesterone will be repeated during the follicular phase). NOTE: If a 17-hydroxyprogesterone > 200 ng/dl is confirmed on repeat testing, an ACTH stimulated 17-hydroxyprogesterone < 1000 ng/dl performed by the subject's personal physician will be required for study participation.
  • Abnormal thyroid stimulating hormone (TSH): Note that subjects with stable and adequately treated primary hypothyroidism, reflected by normal TSH values, will not be excluded.
  • Hyperprolactinemia > 20% higher than the upper limit of normal. Mild prolactin elevations may be seen in women with PCOS, and elevations within 20% higher than the upper limit of normal will be accepted in this group.
  • History and/or physical exam findings suggestive of Cushing's syndrome, adrenal insufficiency, or acromegaly
  • History and/or physical exam findings suggestive of hypogonadotropic hypogonadism (e.g., symptoms of estrogen deficiency) including functional hypothalamic amenorrhea (which may be suggested by a constellation of symptoms including restrictive eating patterns, excessive exercise, psychological stress, etc.)
  • Persistent hematocrit < 37% and hemoglobin < 12 g/dl
  • Severe thrombocytopenia (platelets < 50,000 cells/microliter) or leukopenia (total white blood count < 4,000 cells/microliter)
  • Previous diagnosis of diabetes, fasting glucose > or = 126 mg/dl, or a hemoglobin A1c > or = 6.5%
  • Given that this study involves flutamide use, any liver panel abnormality will be grounds for exclusion
  • Significant history of cardiac or pulmonary dysfunction (e.g., known or suspected congestive heart failure, asthma requiring intermittent systemic corticosteroids, etc.)
  • Decreased renal function evidenced by GFR < 60 ml/min/1.73m2
  • A personal history of breast, ovarian, or endometrial cancer
  • History of allergy to micronized progesterone, flutamide, or transdermal estradiol
  • BMI < 18 or > 40 kg/m2
  • Due to the amount of blood being drawn, volunteers with body weight < 110 pounds must be excluded

Sites / Locations

  • University of VirginiaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Flutamide

Placebo

Arm Description

Prior to the first or second admission (randomly determined), subjects will be pretreated for 4 weeks with Flutamide (250 mg twice daily)

Prior to the first or the second admission (randomly determined), participants will be pretreated for 2 weeks with placebo (twice daily).

Outcomes

Primary Outcome Measures

Change in mean FSH concentration with progesterone administration
Change in mean FSH concentrations (post-progesterone FSH concentrations vs. pre-progesterone FSH concentrations)
Change in mean FSH concentration with progesterone administration
Change in mean FSH concentrations (post-progesterone FSH concentrations vs. pre-progesterone FSH concentrations)

Secondary Outcome Measures

Change in mean LH concentration with progesterone administration
Change in mean LH concentrations (post-progesterone LH concentrations vs. pre-progesterone LH concentrations)
Change in mean LH concentration with progesterone administration
Change in mean LH concentrations (post-progesterone LH concentrations vs. pre-progesterone LH concentrations)

Full Information

First Posted
October 11, 2020
Last Updated
May 16, 2022
Sponsor
University of Virginia
Collaborators
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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1. Study Identification

Unique Protocol Identification Number
NCT04597099
Brief Title
Androgen Blockade and Progesterone Augmentation of Gonadotropin Secretion
Acronym
CRM010
Official Title
Ability of Androgen-receptor Blockade to Normalize Progesterone-induced Augmentation of Gonadotropin Secretion in PCOS (CRM010)
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
December 20, 2022 (Anticipated)
Primary Completion Date
October 1, 2025 (Anticipated)
Study Completion Date
October 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Virginia
Collaborators
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is trying to find out if flutamide (a medication that blocks the effects of testosterone) may help normalize an aspect of pituitary function (specifically, gonadotropin surge generation) in PCOS. This is a randomized, placebo-controlled, double-blinded, crossover study. The investigators hypothesize that in estradiol-pretreated women with PCOS, acute progesterone augmentation of FSH release (positive feedback) will be enhanced by flutamide.
Detailed Description
Women with PCOS appear to exhibit impaired progesterone (P4) augmentation of gonadotropin release (positive feedback), and this is at least partly independent of BMI differences. To test more directly the role of hyperandrogenemia/hyperandrogenism (HA), we will assess if the androgen-receptor blocker flutamide enhances P4 augmentation of gonadotropin release in estradiol (E2)-treated women with PCOS. We will study 10 women with PCOS. This is a randomized, placebo-controlled, double-blinded, crossover study, with subjects undergoing two assessments of P4 positive feedback - once after 4 weeks' pretreatment with flutamide and once after 4-weeks' pretreatment with placebo (in random order). We will assess P4 positive feedback via frequent sampling for 16 hours. Subjects will be pretreated for 3 days (prior to CRU admission) with transdermal E2 (0.2 mg/day), starting no earlier than cycle day 7. Subjects will be admitted to the CRU the evening of day 3 of E2 treatment. Starting at 0200 h, blood will be collected for 16 hours. After 6 h of sampling (0800 h), subjects will receive a single oral dose of P4. A second CRU admission - performed at least 2 months later to permit adequate washout of flutamide (as needed) - will be identical to the first except that placebo pretreatment will be exchanged for flutamide pretreatment or vice versa. We will assess the P4-mediated augmentation of FSH release, with secondary endpoints including the P4-mediated augmentation of LH release. We hypothesize that in E2-pretreated women with PCOS, acute P4 augmentation of FSH release (positive feedback) will be enhanced by androgen-receptor blockade (flutamide).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
PCOS, Polycystic Ovary Syndrome
Keywords
PCOS, Polycystic Ovary Syndrome

7. Study Design

Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Crossover Assignment
Model Description
Randomized, placebo-controlled, double-blinded, crossover study
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Flutamide
Arm Type
Experimental
Arm Description
Prior to the first or second admission (randomly determined), subjects will be pretreated for 4 weeks with Flutamide (250 mg twice daily)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Prior to the first or the second admission (randomly determined), participants will be pretreated for 2 weeks with placebo (twice daily).
Intervention Type
Drug
Intervention Name(s)
Micronized progesterone
Other Intervention Name(s)
progesterone
Intervention Description
oral micronized progesterone suspension, 100 mg oral dose at 0800 during each study admission
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo contains only inert ingredients and is not expected to exert any direct physiological effects.
Intervention Type
Drug
Intervention Name(s)
Flutamide
Intervention Description
Flutamide, 250 mg taken orally twice daily for four weeks before study admission.
Intervention Type
Drug
Intervention Name(s)
Estradiol patch
Other Intervention Name(s)
Vivelle
Intervention Description
Two 0.1 mg/day transdermal estradiol patches will be applied 3 days prior to each inpatient admission; on the morning of study admission, these two patches will be removed and immediately replaced with two new 0.1 mg/day patches.
Primary Outcome Measure Information:
Title
Change in mean FSH concentration with progesterone administration
Description
Change in mean FSH concentrations (post-progesterone FSH concentrations vs. pre-progesterone FSH concentrations)
Time Frame
After 4 weeks of placebo administration
Title
Change in mean FSH concentration with progesterone administration
Description
Change in mean FSH concentrations (post-progesterone FSH concentrations vs. pre-progesterone FSH concentrations)
Time Frame
After 4 weeks of flutamide administration
Secondary Outcome Measure Information:
Title
Change in mean LH concentration with progesterone administration
Description
Change in mean LH concentrations (post-progesterone LH concentrations vs. pre-progesterone LH concentrations)
Time Frame
After 4 weeks of placebo administration
Title
Change in mean LH concentration with progesterone administration
Description
Change in mean LH concentrations (post-progesterone LH concentrations vs. pre-progesterone LH concentrations)
Time Frame
After 4 weeks of flutamide administration

10. Eligibility

Sex
Female
Gender Based
Yes
Gender Eligibility Description
This is a study regarding PCOS, so only females will be eligible
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Post-pubertal (> 4 years post-menarche) adult woman aged 18-30 years PCOS, defined as clinical and/or laboratory evidence of hyperandrogenism (hirsutism and/or elevated serum [calculated] free testosterone concentration) plus ovulatory dysfunction (irregular menses, fewer than 9 per year), but without evidence for other potential causes of hyperandrogenism and/or ovulatory dysfunction General good health (excepting overweight, obesity, hyperandrogenism, PCOS, and adequately-treated hypothyroidism) Capable of and willing to provide informed consent Willing to strictly avoid pregnancy with use of reliable non-hormonal methods during the study period Exclusion Criteria: Inability/incapacity to provide informed consent Males will be excluded (PCOS is unique to females) Age < 18 years or > 30 years (ovarian reserve may decrease beyond age 30) Obesity resulting from a well-defined endocrinopathy or genetic syndrome Positive pregnancy test or current lactation Evidence for non-physiologic or non-PCOS causes of hyperandrogenism and/or anovulation Evidence of virilization (e.g., rapidly progressive hirsutism, deepening of the voice, clitoromegaly) Total testosterone > 150 ng/dl, which suggests the possibility of virilizing ovarian or adrenal tumor DHEA-S elevation > 1.5 times the upper reference range limit. Mild elevations may be seen in PCOS, and will be accepted in these groups Early morning 17-hydroxyprogesterone > 200 ng/dl measured in the follicular phase, which suggests the possibility of congenital adrenal hyperplasia (if elevated during the luteal phase, the 17-hydroxyprogesterone will be repeated during the follicular phase). NOTE: If a 17-hydroxyprogesterone > 200 ng/dl is confirmed on repeat testing, an ACTH stimulated 17-hydroxyprogesterone < 1000 ng/dl performed by the subject's personal physician will be required for study participation. Abnormal thyroid stimulating hormone (TSH): Note that subjects with stable and adequately treated primary hypothyroidism, reflected by normal TSH values, will not be excluded. Hyperprolactinemia > 20% higher than the upper limit of normal. Mild prolactin elevations may be seen in women with PCOS, and elevations within 20% higher than the upper limit of normal will be accepted in this group. History and/or physical exam findings suggestive of Cushing's syndrome, adrenal insufficiency, or acromegaly History and/or physical exam findings suggestive of hypogonadotropic hypogonadism (e.g., symptoms of estrogen deficiency) including functional hypothalamic amenorrhea (which may be suggested by a constellation of symptoms including restrictive eating patterns, excessive exercise, psychological stress, etc.) Persistent hematocrit < 37% and hemoglobin < 12 g/dl Severe thrombocytopenia (platelets < 50,000 cells/microliter) or leukopenia (total white blood count < 4,000 cells/microliter) Previous diagnosis of diabetes, fasting glucose > or = 126 mg/dl, or a hemoglobin A1c > or = 6.5% Given that this study involves flutamide use, any liver panel abnormality will be grounds for exclusion Significant history of cardiac or pulmonary dysfunction (e.g., known or suspected congestive heart failure, asthma requiring intermittent systemic corticosteroids, etc.) Decreased renal function evidenced by GFR < 60 ml/min/1.73m2 A personal history of breast, ovarian, or endometrial cancer History of allergy to micronized progesterone, flutamide, or transdermal estradiol BMI < 18 or > 40 kg/m2 Due to the amount of blood being drawn, volunteers with body weight < 110 pounds must be excluded
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Melissa Gilrain, BS
Phone
4342436911
Email
pcos@virginia.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Christopher M McCartney, MD
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher M McCartney, MD
Organizational Affiliation
Univsersity of Virginia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22901
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Melissa Gilrain, BS
Phone
434-243-6911
Email
pcos@virginia.edu
First Name & Middle Initial & Last Name & Degree
Christopher M McCartney, MD
Phone
434-243-6911
Email
cm2hq@virginia.edu
First Name & Middle Initial & Last Name & Degree
Christopher M McCartney, MD

12. IPD Sharing Statement

Plan to Share IPD
No

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Androgen Blockade and Progesterone Augmentation of Gonadotropin Secretion

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