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Study to Evaluate Efficacy of Vagitocin in Postmenopausal Women With Vulvovaginal Atrophy Symptoms

Primary Purpose

Vulvovaginal Atrophy

Status
Completed
Phase
Phase 2
Locations
Sweden
Study Type
Interventional
Intervention
Oxytocin 400 IU vaginal gel
Placebo
Sponsored by
PepTonic Medical AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Vulvovaginal Atrophy

Eligibility Criteria

40 Years - 65 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Females aged 40-65 years at the time of screening, who are willing to participate in the study as indicated by signing the informed consent.
  • Postmenopausal women with at least 24 months of spontaneous amenorrhea, or women who have had surgical bilateral oophorectomy with or without hysterectomy at least 6 weeks ago.
  • Have ≤ 5% superficial cells in vaginal smear cytology at screening.
  • Have a vaginal pH > 5.0 at screening.
  • Have one moderate to severe vulvovaginal atrophy symptom (vulvar/vaginal irritation and itching, vaginal dryness, dysuria, dyspareunia or presence of vaginal bleeding associated with vaginal sexual activity) that has been identified by the subject as being the most bothersome to her.
  • Have a body mass index (BMI) ≤32 kg/m2.
  • Be judged by the Principal Investigator or Sub-investigator as being in otherwise good health based on a pre-study medical evaluation performed within 21 days prior to the initial dose of study medication. The medical evaluation findings must include a) a normal or clinically non-significant finding at physical examination, b) a normal or clinically non-significant heart rate, c) a mean sitting systolic blood pressure ≤150 mmHg and diastolic blood pressure ≤90 mmHg at screening. Hypertensive subjects controlled with stable medications, who have a blood pressure ≤150 mmHg (systolic) and ≤ 90 (diastolic) mmHg are suitable for inclusion, d) a normal or clinically non-significant finding at gynaecological examination, e) a normal mammography (no masses or other diagnosed findings suspected of being malignant) that has been performed within 36 months prior to initial dose of study medication, f) a normal or clinically non-significant finding at clinical breast examination (no masses or other findings suspected of being malignant), g) an acceptable Papanicolaou ("Pap") smear for subjects with an intact uterus and cervix (no dysplastic or malignant cells), h) laboratory values within normal limits or with non-significant deviations from normal values.
  • Have an endometrial thickness of <4 mm as determined by vaginal ultrasonography, in women with an intact uterus.
  • Be willing to abstain from vaginal sexual activity and the use of vaginal douching within 24 hours prior to vaginal pH measurements at screening and at Visits 2 and 3.

Exclusion Criteria:

  • Currently hospitalized.
  • Have a history or ongoing cardiovascular, hepatic, renal, pulmonary, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurologic, psychological, or musculoskeletal disease or disorder that is clinically significant in the opinion of the Principal Investigator or Sub-Investigator.
  • Have had or have any known or suspected tumor disease that is clinically significant in the opinion of the Principal Investigator or Sub-Investigator.
  • Have a history of endometrial hyperplasia or uterine/endometrial, breast or ovarian cancer.
  • Have a history of undiagnosed vaginal bleeding.
  • Have an ongoing urogenital infection in spite of treatment at the randomization visit.
  • Any contraindication to oxytocin therapy and allergy to the use of oxytocin and any components of the investigational drugs.
  • Have a history of drug and/or alcohol abuse within one year of start of study.
  • Have used any prescription or over-the-counter medications including phytoestrogens, herbal medicinal products or hormonal intra-uterine device with known estrogenic effects within 12 weeks prior to the screening visit.
  • Have used any type of vaginal lubricants and moisturizers within 24 hours prior to the screening visit.
  • Have used estrogen alone or estrogen/progestin for any of the following time periods: a) vaginal hormonal products (rings, creams, gels, vaginal suppositories) within 12 weeks prior to the screening visit, b) transdermal estrogen alone or estrogen/progestin products including percutaneous estrogen gels for at least 12 weeks prior to the screening visit, c) oral estrogen and/or progestin therapy within 12 weeks prior to the screening visit, d) intrauterine progestin therapy within 12 weeks prior to the screening visit, e) progestin implants and estrogen alone injectable drug therapy within 12 weeks prior to the screening visit, f) estrogen pellet therapy or progestational injectable drug therapy within 6 months prior to the screening visit.
  • Have any reason, which in the opinion of the Principal Investigator or Sub-Investigator would prevent the subject from safely participating in the study or complying with protocol requirements.
  • Have participated in another clinical study within 90 days prior to screening, have received an investigational drug within three months prior to the initial dose of study medication, or be likely to participate in another clinical study or receive another investigational medication during the study.
  • Have contraindication to any planned study procedure.
  • Pregnancy.

Sites / Locations

  • Kvinnoforskningsenheten K59, Karolinska Universitetssjukhuset
  • Kvinnokliniken, Norrlands Universitetssjukhus
  • Kvinnokliniken, Akademiska sjukhuset

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Oxytocin 400 IU

Placebo

Arm Description

1mL Oxytocin 400 IU vaginal gel once daily for 12 weeks

1mL Placebo vaginal gel once daily for 12 weeks

Outcomes

Primary Outcome Measures

Change in severity of the most bothersome VVA symptom.
Change in severity of the VVA symptom (vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness, dysuria or the absence or presence of vaginal bleeding associated with vaginal sexual activity [yes/no]) that has been self-identified by the subject as being the most bothersome to her at baseline.

Secondary Outcome Measures

Change in vaginal pH
Change in vaginal pH (decrease is positive).
Change in % superficial cells
Change in % superficial cells in vaginal smear (increase is positive).
Change in maturation value
Change in maturation value (MV) (increase is positive). Maturation value is calculated using the percentage of parabasal cells, intermediate cells, and superficial cells in vaginal smear.
Change in summary score for the vulvovaginal atrophy symptoms.
Change in summary score for the VVA symptoms vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness and dysuria (decrease is positive).
Change in severity of the most bothersome VVA symptom.
Change in severity of the VVA symptom (vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness, dysuria or the absence or presence of vaginal bleeding associated with vaginal sexual activity [yes/no]) that has been self-identified by the subject as being the most bothersome to her at baseline.
Change in % superficial cells
Change in % superficial cells in vaginal smear (increase is positive).
Change in vaginal pH
Change in vaginal pH (decrease is positive).
Change in % parabasal cells
Change in % parabasal cells (decrease is positive).
Change in maturation value
Change in maturation value (MV) (increase is positive). Maturation value is calculated using the percentage of parabasal cells, intermediate cells, and superficial cells in vaginal smear.
Change in severity of the most bothersome VVA symptom.
Change in severity of the VVA symptom (vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness, dysuria or the absence or presence of vaginal bleeding associated with vaginal sexual activity [yes/no]) that has been self-identified by the subject as being the most bothersome to her at baseline.
Change in Quality of Life evaluation parameters.
Change in Quality of Life evaluation parameters.
Change in body weight.
Change in body weight.
Change over time of clinical safety data.
Change over time of clinical safety data (adverse events, vital signs, physical, gynecological and breast examination findings, laboratory tests, transvaginal ultrasound and pap smear).

Full Information

First Posted
May 8, 2017
Last Updated
November 10, 2020
Sponsor
PepTonic Medical AB
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1. Study Identification

Unique Protocol Identification Number
NCT04629885
Brief Title
Study to Evaluate Efficacy of Vagitocin in Postmenopausal Women With Vulvovaginal Atrophy Symptoms
Official Title
A Phase 2b, Double-blind, Randomized, Parallel, Placebo-Controlled Study to Evaluate the 12-week Efficacy of Vagitocin in Postmenopausal Women With Symptoms of Vulvovaginal Atrophy
Study Type
Interventional

2. Study Status

Record Verification Date
November 2020
Overall Recruitment Status
Completed
Study Start Date
May 3, 2016 (Actual)
Primary Completion Date
May 3, 2017 (Actual)
Study Completion Date
May 3, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
PepTonic Medical AB

4. Oversight

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

5. Study Description

Brief Summary
A randomized, double-blind, placebo controlled Phase 2b study, divided in 2 parts: The main part of the study investigates the efficacy and safety of the Investigational Medicinal Product (IMP), intravaginally administered in glass syringes, on postmenopausal women with vulvovaginal atrophy symptoms. The exploratory part of the study investigates the efficacy and safety of the IMP, intravaginally administered in a laminate tube, on postmenopausal women with vulvovaginal atrophy symptoms. A comparison of plasma levels of oxytocin when the IMP is administered by 2 different applicators will be investigated in a sub-group of patients. In the main part, 160 subjects are enrolled and randomized to 2 different groups; 80 subjects receiving IMP and 80 subjects receiving placebo, in glass syringes. In the exploratory part of the study, 40 patients will be enrolled and randomized to 2 different groups; 30 subjects receiving IMP and 10 patients receiving placebo, in laminate tubes. The study is conducted at 3 sites in Sweden, and comprises 5 visits: screening visit (Visit 0), randomization visit (Visit 1; Day 0), treatment follow-up visit (Visit 2; Week 4), end of treatment visit (Visit 3; Week 12) and a telephone follow-up visit (Visit 4; Week 14). All patients self-administer the IMP once daily for 12 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Vulvovaginal Atrophy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
202 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Oxytocin 400 IU
Arm Type
Experimental
Arm Description
1mL Oxytocin 400 IU vaginal gel once daily for 12 weeks
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
1mL Placebo vaginal gel once daily for 12 weeks
Intervention Type
Drug
Intervention Name(s)
Oxytocin 400 IU vaginal gel
Other Intervention Name(s)
Vagitocin
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Placebo (for Vagitocin)
Intervention Description
Matching placebo gel with identical appearance to the test product, used as reference treatment.
Primary Outcome Measure Information:
Title
Change in severity of the most bothersome VVA symptom.
Description
Change in severity of the VVA symptom (vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness, dysuria or the absence or presence of vaginal bleeding associated with vaginal sexual activity [yes/no]) that has been self-identified by the subject as being the most bothersome to her at baseline.
Time Frame
Baseline and after 12 weeks of treatment.
Secondary Outcome Measure Information:
Title
Change in vaginal pH
Description
Change in vaginal pH (decrease is positive).
Time Frame
Baseline and 12 weeks of treatment.
Title
Change in % superficial cells
Description
Change in % superficial cells in vaginal smear (increase is positive).
Time Frame
Baseline and 12 weeks of treatment.
Title
Change in maturation value
Description
Change in maturation value (MV) (increase is positive). Maturation value is calculated using the percentage of parabasal cells, intermediate cells, and superficial cells in vaginal smear.
Time Frame
Baseline and 12 weeks of treatment.
Title
Change in summary score for the vulvovaginal atrophy symptoms.
Description
Change in summary score for the VVA symptoms vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness and dysuria (decrease is positive).
Time Frame
Baseline and 12 weeks of treatment.
Title
Change in severity of the most bothersome VVA symptom.
Description
Change in severity of the VVA symptom (vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness, dysuria or the absence or presence of vaginal bleeding associated with vaginal sexual activity [yes/no]) that has been self-identified by the subject as being the most bothersome to her at baseline.
Time Frame
Baseline and 4 weeks of treatment.
Title
Change in % superficial cells
Description
Change in % superficial cells in vaginal smear (increase is positive).
Time Frame
Baseline and 4 weeks of treatment.
Title
Change in vaginal pH
Description
Change in vaginal pH (decrease is positive).
Time Frame
Baseline and 4 weeks of treatment.
Title
Change in % parabasal cells
Description
Change in % parabasal cells (decrease is positive).
Time Frame
Baseline and 4 and 12 weeks of treatment.
Title
Change in maturation value
Description
Change in maturation value (MV) (increase is positive). Maturation value is calculated using the percentage of parabasal cells, intermediate cells, and superficial cells in vaginal smear.
Time Frame
Baseline and 4 weeks of treatment.
Title
Change in severity of the most bothersome VVA symptom.
Description
Change in severity of the VVA symptom (vulvar/vaginal irritation and itching, dyspareunia, vaginal dryness, dysuria or the absence or presence of vaginal bleeding associated with vaginal sexual activity [yes/no]) that has been self-identified by the subject as being the most bothersome to her at baseline.
Time Frame
Baseline and 4 and 12 weeks of treatment.
Title
Change in Quality of Life evaluation parameters.
Description
Change in Quality of Life evaluation parameters.
Time Frame
Baseline and 12 weeks of treatment
Title
Change in body weight.
Description
Change in body weight.
Time Frame
Baseline and 12 weeks of treatment
Title
Change over time of clinical safety data.
Description
Change over time of clinical safety data (adverse events, vital signs, physical, gynecological and breast examination findings, laboratory tests, transvaginal ultrasound and pap smear).
Time Frame
Baseline and up to 14 weeks after first dose.
Other Pre-specified Outcome Measures:
Title
Plasma concentrations of oxytocin administered by two different applicators.
Description
Oxytocin levels in plasma measured in 20 subjects treated with Oxytocin administered in glass syringe and in 16 subjects treated with Oxytocin administered in laminate tube.
Time Frame
30 minutes pre-dose, pre-dose (t=0), 15, 30, 60, 120 and 240 minutes post-dose.

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Females aged 40-65 years at the time of screening, who are willing to participate in the study as indicated by signing the informed consent. Postmenopausal women with at least 24 months of spontaneous amenorrhea, or women who have had surgical bilateral oophorectomy with or without hysterectomy at least 6 weeks ago. Have ≤ 5% superficial cells in vaginal smear cytology at screening. Have a vaginal pH > 5.0 at screening. Have one moderate to severe vulvovaginal atrophy symptom (vulvar/vaginal irritation and itching, vaginal dryness, dysuria, dyspareunia or presence of vaginal bleeding associated with vaginal sexual activity) that has been identified by the subject as being the most bothersome to her. Have a body mass index (BMI) ≤32 kg/m2. Be judged by the Principal Investigator or Sub-investigator as being in otherwise good health based on a pre-study medical evaluation performed within 21 days prior to the initial dose of study medication. The medical evaluation findings must include a) a normal or clinically non-significant finding at physical examination, b) a normal or clinically non-significant heart rate, c) a mean sitting systolic blood pressure ≤150 mmHg and diastolic blood pressure ≤90 mmHg at screening. Hypertensive subjects controlled with stable medications, who have a blood pressure ≤150 mmHg (systolic) and ≤ 90 (diastolic) mmHg are suitable for inclusion, d) a normal or clinically non-significant finding at gynaecological examination, e) a normal mammography (no masses or other diagnosed findings suspected of being malignant) that has been performed within 36 months prior to initial dose of study medication, f) a normal or clinically non-significant finding at clinical breast examination (no masses or other findings suspected of being malignant), g) an acceptable Papanicolaou ("Pap") smear for subjects with an intact uterus and cervix (no dysplastic or malignant cells), h) laboratory values within normal limits or with non-significant deviations from normal values. Have an endometrial thickness of <4 mm as determined by vaginal ultrasonography, in women with an intact uterus. Be willing to abstain from vaginal sexual activity and the use of vaginal douching within 24 hours prior to vaginal pH measurements at screening and at Visits 2 and 3. Exclusion Criteria: Currently hospitalized. Have a history or ongoing cardiovascular, hepatic, renal, pulmonary, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurologic, psychological, or musculoskeletal disease or disorder that is clinically significant in the opinion of the Principal Investigator or Sub-Investigator. Have had or have any known or suspected tumor disease that is clinically significant in the opinion of the Principal Investigator or Sub-Investigator. Have a history of endometrial hyperplasia or uterine/endometrial, breast or ovarian cancer. Have a history of undiagnosed vaginal bleeding. Have an ongoing urogenital infection in spite of treatment at the randomization visit. Any contraindication to oxytocin therapy and allergy to the use of oxytocin and any components of the investigational drugs. Have a history of drug and/or alcohol abuse within one year of start of study. Have used any prescription or over-the-counter medications including phytoestrogens, herbal medicinal products or hormonal intra-uterine device with known estrogenic effects within 12 weeks prior to the screening visit. Have used any type of vaginal lubricants and moisturizers within 24 hours prior to the screening visit. Have used estrogen alone or estrogen/progestin for any of the following time periods: a) vaginal hormonal products (rings, creams, gels, vaginal suppositories) within 12 weeks prior to the screening visit, b) transdermal estrogen alone or estrogen/progestin products including percutaneous estrogen gels for at least 12 weeks prior to the screening visit, c) oral estrogen and/or progestin therapy within 12 weeks prior to the screening visit, d) intrauterine progestin therapy within 12 weeks prior to the screening visit, e) progestin implants and estrogen alone injectable drug therapy within 12 weeks prior to the screening visit, f) estrogen pellet therapy or progestational injectable drug therapy within 6 months prior to the screening visit. Have any reason, which in the opinion of the Principal Investigator or Sub-Investigator would prevent the subject from safely participating in the study or complying with protocol requirements. Have participated in another clinical study within 90 days prior to screening, have received an investigational drug within three months prior to the initial dose of study medication, or be likely to participate in another clinical study or receive another investigational medication during the study. Have contraindication to any planned study procedure. Pregnancy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Aino Fianu Jonasson, MD
Organizational Affiliation
Kvinnoforskningsenheten K59, Karolinska Universitetssjukhuset, Huddinge
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kvinnoforskningsenheten K59, Karolinska Universitetssjukhuset
City
Huddinge
ZIP/Postal Code
14186
Country
Sweden
Facility Name
Kvinnokliniken, Norrlands Universitetssjukhus
City
Umeå
ZIP/Postal Code
90185
Country
Sweden
Facility Name
Kvinnokliniken, Akademiska sjukhuset
City
Uppsala
ZIP/Postal Code
75185
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
No

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Study to Evaluate Efficacy of Vagitocin in Postmenopausal Women With Vulvovaginal Atrophy Symptoms

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