Recombinant Follicle-stimulating Hormone in Treatment for Infertility (REFRESH)
Primary Purpose
Female Infertility
Status
Active
Phase
Phase 3
Locations
India
Study Type
Interventional
Intervention
Recombinant Human Follicle Stimulating Hormone 900 IU (66.0 μg) / 1.5mL Solution for Injection in Prefilled Pen
Sponsored by
About this trial
This is an interventional treatment trial for Female Infertility
Eligibility Criteria
Inclusion Criteria:
- Subject has indication ART using COS.
- Subject has regular menstrual cycle of 21-35 days.
Subject has one of the following:
- FSH level <10 IU/L and Estradiol levl <80 pg/mL at day 2 or 3
- Anti-mullerian hormone (AMH) level between 1 to 3.5 ng/mL during the menstrual cycle
- Subject has an antral follicle count (AFC) of 10- 25, follicle ≤10 mm in diameter before ovarian stimulation
- Subject has a BMI ≥18 and <30 kg/m2
- Subject has results of clinical laboratory tests within normal reference range
- Subject and her partner are willing to provide written informed consent and comply
Exclusion Criteria Details Subject has history of >2 failed ART cycles
- Subject with history of any endocrine abnormality, with documented hormone levels outside the reference range, which are clinically relevant, at screening
- Subject with a history of ovarian hyper-response (i.e., previous COS cycle with >25 follicles of ≥11 mm in diameter on USG) or OHSS
- Subject with documented polycystic ovarian syndrome (PCOS) at the time of screening
- Subject with only one ovary or ovarian abnormality (including endometrioma >10 mm; visible on USG), at screening
- Subject with documented severe endometriosis (American Society of Reproductive Medicine stage 3 or stage 4) or hydrosalpinx, at screening
- Subject with submucosal fibroids ≥5 cm or any other clinically relevant pathology, which could impair embryo implantation or pregnancy continuation, at screening
- Subject with a history of extrauterine pregnancy within 3 months of screening
- Subject with history of poor response to gonadotropin treatment (retrieval of <4 oocytes) in the previous ART cycle
- Subject with history of ≥3 miscarriages, at any time prior to screening
- Subject who has tested positive for Human Immunodeficiency Virus, Hepatitis B or Hepatitis C at screening
- Subject known to be allergic, hypersensitive, or intolerant to any of the preparations of r hFSH or its excipients, that will be used in the study
- Subject with contraindications to the use of gonadotropins (e.g., tumours, undiagnosed vaginal bleeding, or ovarian cysts) or gonadotropin-releasing hormone (GnRH) antagonists
- Subject with a history of epilepsy, thrombophilia, cardiovascular, gastrointestinal, hepatic, renal, pulmonary, auto-immune disease, or any active infection, requiring treatment which at the investigator's discretion might interfere with the study
- Subject with history of malignancy
- Subject who smokes or has stopped smoking within the last 3 months prior to screening
- Subject with history of alcohol or drug abuse within 12 months prior to screening
Subject who has received any treatment listed below within 5 half-lives prior to screening:
- Any agent(s) known to affect ovulation (e.g., neuroleptics);
- Drugs known or suspected to be teratogenic in nature.
Sites / Locations
- Om Research Center Om Surgical Center and Maternity Home
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Test group
Reference group
Arm Description
Foligraf 900 IU (66.0 μg) / 1.5mL Solution for Injection in Prefilled Pen Follicle Stimulating Hormone (Human Recombinant) manufactured by Bharat Serums and Vaccines Ltd
Gonal-f Recombinant Human Follicle Stimulating Hormone
Outcomes
Primary Outcome Measures
Number of oocytes retrieved
Number of oocytes retrieved
Secondary Outcome Measures
Clinical pregnancy rate
Clinical pregnancy rate
Ongoing Pregnancy rate
Ongoing pregnancy rate
Cycle cancellation rate
Cycle cancellation rate
Total Doseof r-hFSH
Total dose of r-hFSH (in IU) required for ovarian stimulation;
Number of Days of r-hFSH stimulation
Number of days of r-hFSH stimulation
Number of subject Change in Dosage
Proportion of subjects requiring change in dose
Hormonal Investigation
Estradiol, Luteinizing, Progesterone, and inhibin b levels
Follicle size on Day 6
Number of follicles with size <11mm, Number of follicles with size 11- 14 mm, Number of follicles with size15 mm, Number of follicles with size16 mm, Number of follicles with size17 mm and Number of follicles with size ≥18 mm
Follicle size at HCG administration
Number of follicles with size <11mm, Number of follicles with size 11- 14 mm, Number of follicles with size15 mm, Number of follicles with size16 mm, Number of follicles with size17 mm and Number of follicles with size ≥18 mm mm)
Endometrium thickness
Endometrial thickness (mm)
Endometrium at HCG administration
Endometrial thickness (mm)
Number of Matured oocytes
Proportion of matured oocytes
Number of good quality embryos
Number of good quality embryos
Number of Adverse events
Number of treatment-emergent adverse events (TEAE) reported
Specific adverse events
The number of patients with ovarian hyperstimulation syndrome (OHSS) reported
Exploratory
Ease of use of Pen - comparison of total score of Questionnaire to user of rhFSH pen
Evaluation of immunogenicity (antibody) of r-hFSH
Evaluation of immunogenicity of r-hFSH, comparison of antibody titre against r-hFSH in both groups
Full Information
NCT ID
NCT05266924
First Posted
January 23, 2022
Last Updated
July 31, 2023
Sponsor
Bharat Serums and Vaccines Limited
1. Study Identification
Unique Protocol Identification Number
NCT05266924
Brief Title
Recombinant Follicle-stimulating Hormone in Treatment for Infertility
Acronym
REFRESH
Official Title
A Randomized, Parallel-group, Multi-Center, Assessor-blind Phase 3 Study to Compare the Efficacy, Safety and Ease of Use of Two Follicle Stimulating Hormone -Human Recombinant (r-hFSH) 900 IU (66.0 μg) / 1.5mL Solution for Injection in Prefilled Pen (Foligraf®- Manufactured by BSV and Gonal-f® Manufactured by Merck Serono) in Subjects Undergoing Controlled Ovarian Stimulation for Assisted Reproductive Technology
Study Type
Interventional
2. Study Status
Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 23, 2022 (Actual)
Primary Completion Date
August 31, 2023 (Anticipated)
Study Completion Date
November 30, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Bharat Serums and Vaccines Limited
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
This is a randomized multi-centre, assessor-blind, parallel-group study to be conducted in 250 women in the age group of 20 to 39 years (both inclusive), who are indicated to undergo COS as part of assisted reproductive technology (ART). The participant will receive r-hFSH, fixed-dose for 5 days, and day 6 onwards the dose may be adjusted for a single cycle of COS followed by ART procedures, and post-ART follow-up for ongoing pregnancy.
The primary and secondary outcomes will be captured on days as per protocol. Adverse events will be noted for safety evaluation.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Female Infertility
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
This is a Randomized, Parallel-group, Multi-Center, Assessor-blind Phase 3 Study.
Masking
InvestigatorOutcomes Assessor
Masking Description
The assessor including the investigator, outcoume assessor (sonography, embyrologist) shall be blinded.
Allocation
Randomized
Enrollment
250 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Test group
Arm Type
Experimental
Arm Description
Foligraf 900 IU (66.0 μg) / 1.5mL Solution for Injection in Prefilled Pen Follicle Stimulating Hormone (Human Recombinant) manufactured by Bharat Serums and Vaccines Ltd
Arm Title
Reference group
Arm Type
Active Comparator
Arm Description
Gonal-f Recombinant Human Follicle Stimulating Hormone
Intervention Type
Drug
Intervention Name(s)
Recombinant Human Follicle Stimulating Hormone 900 IU (66.0 μg) / 1.5mL Solution for Injection in Prefilled Pen
Other Intervention Name(s)
Foligraf, Gonal-f
Intervention Description
fixed-dose of 225 IU/day, subcutaneous (SC), daily, for 5 days. further dosage will be adjusted till adequate follicular development.
Primary Outcome Measure Information:
Title
Number of oocytes retrieved
Description
Number of oocytes retrieved
Time Frame
Oocyte pick up - up to ~ 34 to 36 hours after human chorionic gonadotropin (hCG) administration
Secondary Outcome Measure Information:
Title
Clinical pregnancy rate
Description
Clinical pregnancy rate
Time Frame
4 weeks after embryo transfer (ET)
Title
Ongoing Pregnancy rate
Description
Ongoing pregnancy rate
Time Frame
11±1 weeks after ET
Title
Cycle cancellation rate
Description
Cycle cancellation rate
Time Frame
at Stimulation phase up to 20 days, oocyte pick up up to ~ 34 to 36 hours after hCG administration, ET anytime up to 8 weeks
Title
Total Doseof r-hFSH
Description
Total dose of r-hFSH (in IU) required for ovarian stimulation;
Time Frame
at end of stimulation up to 20 days
Title
Number of Days of r-hFSH stimulation
Description
Number of days of r-hFSH stimulation
Time Frame
at end of stimulation up to 20 days
Title
Number of subject Change in Dosage
Description
Proportion of subjects requiring change in dose
Time Frame
post Day 6 till end of stimulation up to 20 days
Title
Hormonal Investigation
Description
Estradiol, Luteinizing, Progesterone, and inhibin b levels
Time Frame
Day 6
Title
Follicle size on Day 6
Description
Number of follicles with size <11mm, Number of follicles with size 11- 14 mm, Number of follicles with size15 mm, Number of follicles with size16 mm, Number of follicles with size17 mm and Number of follicles with size ≥18 mm
Time Frame
Day 6
Title
Follicle size at HCG administration
Description
Number of follicles with size <11mm, Number of follicles with size 11- 14 mm, Number of follicles with size15 mm, Number of follicles with size16 mm, Number of follicles with size17 mm and Number of follicles with size ≥18 mm mm)
Time Frame
Day of hCG administration anytime upto 3 weeks
Title
Endometrium thickness
Description
Endometrial thickness (mm)
Time Frame
day 6
Title
Endometrium at HCG administration
Description
Endometrial thickness (mm)
Time Frame
day of hCG injection (anytime upto 3 weeks)
Title
Number of Matured oocytes
Description
Proportion of matured oocytes
Time Frame
Oocyte pick up ~ 34 to 36 hours after hCG administration
Title
Number of good quality embryos
Description
Number of good quality embryos
Time Frame
ET day (up to 8 weeks)
Title
Number of Adverse events
Description
Number of treatment-emergent adverse events (TEAE) reported
Time Frame
Baseline, 1st day of stimulation, day 6 , end of stimulation up to 20 days, hCG administration, oocyte pick up ~ 34 to 36 hours after hCG administration, ET up to 8 weeks, clinical pregnancy (after 4 weeks of ET), ~12 weeks after ET
Title
Specific adverse events
Description
The number of patients with ovarian hyperstimulation syndrome (OHSS) reported
Time Frame
Day 1 of Stimulation till ~12 weeks after ET
Title
Exploratory
Description
Ease of use of Pen - comparison of total score of Questionnaire to user of rhFSH pen
Time Frame
End of stimulation up to 20 days
Title
Evaluation of immunogenicity (antibody) of r-hFSH
Description
Evaluation of immunogenicity of r-hFSH, comparison of antibody titre against r-hFSH in both groups
Time Frame
Baseline, 4 weeks and 12 weeks
10. Eligibility
Sex
Female
Gender Based
Yes
Gender Eligibility Description
Female
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
39 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subject has indication ART using COS.
Subject has regular menstrual cycle of 21-35 days.
Subject has one of the following:
FSH level <10 IU/L and Estradiol levl <80 pg/mL at day 2 or 3
Anti-mullerian hormone (AMH) level between 1 to 3.5 ng/mL during the menstrual cycle
Subject has an antral follicle count (AFC) of 10- 25, follicle ≤10 mm in diameter before ovarian stimulation
Subject has a BMI ≥18 and <30 kg/m2
Subject has results of clinical laboratory tests within normal reference range
Subject and her partner are willing to provide written informed consent and comply
Exclusion Criteria Details Subject has history of >2 failed ART cycles
Subject with history of any endocrine abnormality, with documented hormone levels outside the reference range, which are clinically relevant, at screening
Subject with a history of ovarian hyper-response (i.e., previous COS cycle with >25 follicles of ≥11 mm in diameter on USG) or OHSS
Subject with documented polycystic ovarian syndrome (PCOS) at the time of screening
Subject with only one ovary or ovarian abnormality (including endometrioma >10 mm; visible on USG), at screening
Subject with documented severe endometriosis (American Society of Reproductive Medicine stage 3 or stage 4) or hydrosalpinx, at screening
Subject with submucosal fibroids ≥5 cm or any other clinically relevant pathology, which could impair embryo implantation or pregnancy continuation, at screening
Subject with a history of extrauterine pregnancy within 3 months of screening
Subject with history of poor response to gonadotropin treatment (retrieval of <4 oocytes) in the previous ART cycle
Subject with history of ≥3 miscarriages, at any time prior to screening
Subject who has tested positive for Human Immunodeficiency Virus, Hepatitis B or Hepatitis C at screening
Subject known to be allergic, hypersensitive, or intolerant to any of the preparations of r hFSH or its excipients, that will be used in the study
Subject with contraindications to the use of gonadotropins (e.g., tumours, undiagnosed vaginal bleeding, or ovarian cysts) or gonadotropin-releasing hormone (GnRH) antagonists
Subject with a history of epilepsy, thrombophilia, cardiovascular, gastrointestinal, hepatic, renal, pulmonary, auto-immune disease, or any active infection, requiring treatment which at the investigator's discretion might interfere with the study
Subject with history of malignancy
Subject who smokes or has stopped smoking within the last 3 months prior to screening
Subject with history of alcohol or drug abuse within 12 months prior to screening
Subject who has received any treatment listed below within 5 half-lives prior to screening:
Any agent(s) known to affect ovulation (e.g., neuroleptics);
Drugs known or suspected to be teratogenic in nature.
Facility Information:
Facility Name
Om Research Center Om Surgical Center and Maternity Home
City
Varanasi
State/Province
Uttar Pradesh
ZIP/Postal Code
221007
Country
India
12. IPD Sharing Statement
Plan to Share IPD
No
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Recombinant Follicle-stimulating Hormone in Treatment for Infertility
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