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Cannabidiol and Management of Endometriosis Pain

Primary Purpose

Endometriosis, CBD, Pelvic Pain

Status
Recruiting
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Cannabidiol (CBD) Extract
Norethindrone Acetate
Placebo
Sponsored by
Milton S. Hershey Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Endometriosis focused on measuring endometriosis, CBD, pelvic pain

Eligibility Criteria

18 Years - 45 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Females ages 18-45 years at the time of enrollment
  2. A surgical diagnosis with direct visualization and/or histopathologic confirmation of endometriosis with associated moderate to severe endometriosis related pain ( > 3 on a VAS)
  3. Is not expected to undergo gynecological surgery or other surgical procedure for treatment of endometriosis during the study period
  4. Agrees to use approved contraception during the entire study if not surgically sterile
  5. Patients using oral contraceptives, vaginal ring, injectable progesterone and/or GnRH agonists/antagonist for contraception and/or management of endometriosis, can be included if both they and their primary provider agree to stopping their medication and transitioning to Norethindrone acetate (NETA) as the primary treatment of endometriosis throughout the study period.
  6. Patients using Long-acting reversible contraceptives (LARCs) for contraception and/or management of endometriosis can be included if both they and their primary provider agree to initiate Norethindrone (NETA) as the primary treatment of endometriosis throughout the study period

Exclusion Criteria:

  1. Women that are pregnant, breastfeeding or trying to conceive
  2. Women with chronic daily opioid use and any chronic pain or frequently reoccurring pain condition, other than endometriosis, that is treated with opioids for > 14 days per month.
  3. Women that are currently using Cannabis based products or have used them within 30 days of enrollment
  4. Non-English speaking or inability to read and understand English
  5. Women with a BMI > 35 kg/m2
  6. Women with known liver disease, such as hepatitis, or with screening LFTS (AST/ALT) > 3 times above the upper limits of normal (ULN) in the past year
  7. Women with chronic alcohol use (defined as > 3 drinks per day, averaged over one week)
  8. Women with chronic use of drugs (defined as > 10 days/month) that cause somnolence/sedation such as benzodiazepines or Central Nervous System (CNS) depressants that are unwilling or unable to discontinue the medications for the washout period and the duration of the study
  9. Women who are currently taking Clobazam or Valproate and are unwilling/unable to discontinue the medication for the washout period and the duration of the study
  10. Women with suicidal ideation or uncontrolled depression within the past year
  11. Known history of or suspected breast cancer on screening physical exam
  12. History of or active deep venous thrombosis or pulmonary embolism
  13. History of or active arterial thromboembolic event (e.g. stroke, myocardial infarction)
  14. Multiple (> 3) risk factors for arterial vascular disease (e.g. uncontrolled hypertension, diabetes mellitus, hypercholesterolemia, obesity and smoking)
  15. Current use of a progestin-containing contraceptive implant

Sites / Locations

  • Penn State Health Milton S. Hershey Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Placebo Comparator

Active Comparator

Active Comparator

Arm Label

Group A - Placebo

Group B - Low Dose CBD

Group C - High Dose CBD

Arm Description

Norethindrone acetate (5mg daily) + Placebo

Norethindrone acetate (5mg daily) + Low dose CBD (10mg sublingual daily)

Norethindrone acetate (5mg daily) + High dose CBD (20mg sublingual daily)

Outcomes

Primary Outcome Measures

Pain Score
Pain will be reported daily using the Visual Analog Scale, a 100mm horizontal line on which the patient's pain intensity is represented by a point between the extremities of 0 (no pain) and 100 (worst pain). The primary study endpoint will be compared between groups using the area under the curve.

Secondary Outcome Measures

Change in Total FSFI Score
The Female Sexual Function Index (FSFI) is a validated survey. The total FSFI score ranges from 2 (low sexual function) to 36 (high sexual function).
Change in EHP-30 Core Domain
The Endometriosis Health Profile-30 (EHP-30) is a validated questionnaire measuring quality of life in women with endometriosis. A summary score is calculated for the core domain on a scale of 0 to 100 (0 indicates the best possible health status whereas 100 indicates the worst possible health status).

Full Information

First Posted
August 21, 2020
Last Updated
October 10, 2023
Sponsor
Milton S. Hershey Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT04527003
Brief Title
Cannabidiol and Management of Endometriosis Pain
Official Title
A Randomized Controlled Pilot Study of the Use of Cannabidiol in the Management of Endometriosis Pain
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 4, 2020 (Actual)
Primary Completion Date
June 30, 2024 (Anticipated)
Study Completion Date
December 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Milton S. Hershey Medical Center

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
The investigators are looking to conduct a study looking at the effects of cannabidiol (CBD) in patients with endometriosis. It is believed that CBD will improve both pain and quality of life. The study will last a total of 12 weeks and involve several onsite visits in addition to daily pain assessments.
Detailed Description
The proposal is to conduct a randomized double-blind placebo-controlled pilot study to evaluate the effectiveness of cannabidiol on the management of endometriosis-related pain. Subjects will be pre-screened from new and existing patients as well as from referral sites for the diagnosis of endometriosis. Potential subjects will be pre-screened for moderate to severe endometriosis associated pain (VAS > 3) greater than 6 months. Those meeting all inclusion and exclusion criteria that who are willing to participate will receive a detailed history and physical exam, appropriate bloodwork and undergo informed consented at the Screening Visit. Baseline survey data will be collected. During Screening, the patient's will be asked to complete their daily electronic diaries and screened for daily reporting adherence. Randomized subjects will receive either (1) placebo (2) low dose CBD (3) high dose CBD. This study will include an 8-week intervention period during which subjects will be asked to record daily electronic VAS scores, pain medication use and a number of other parameters. Subjects will return at week 12 for a 4 week post-treatment visit, where they can also chose to enroll in an optional pharmacokinetic study. Participants will complete the Endometriosis Health Profile-30 (EHP-30), Patient Global Assessments (PGAs), the Patient Global Impression of Change (PGIC) surveys and, if partnered and sexually active, the Female Sexual Function Index at various time points. Patients will also have bloodwork done to assess for circulating markers of inflammation, circulating CBD concentration levels and liver dysfunction throughout the study duration. Subjects will be screened for side effects and asked to record pain medication use throughout the duration of the study. Study drug compliance will be assessed. At the completion of the study, all subjects will be offered the opportunity to do pharmacokinetic testing with sublingual CBD until a maximum number of 4 patients are enrolled. The testing will include 24 hours of monitoring with sequential blood draws to determine the pharmacokinetic parameters of sublingual CBD after administration and one salivary pH. They will be discharged at 24 hours and asked to return to the clinic at 48 hours for one final lab draw.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Endometriosis, CBD, Pelvic Pain
Keywords
endometriosis, CBD, pelvic pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Masking Description
Double-blind of study team (PI, Sub-I's and all research staff) and subjects. Randomization will be completed by Investigational Pharmacy and will keep the blind.
Allocation
Randomized
Enrollment
36 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group A - Placebo
Arm Type
Placebo Comparator
Arm Description
Norethindrone acetate (5mg daily) + Placebo
Arm Title
Group B - Low Dose CBD
Arm Type
Active Comparator
Arm Description
Norethindrone acetate (5mg daily) + Low dose CBD (10mg sublingual daily)
Arm Title
Group C - High Dose CBD
Arm Type
Active Comparator
Arm Description
Norethindrone acetate (5mg daily) + High dose CBD (20mg sublingual daily)
Intervention Type
Drug
Intervention Name(s)
Cannabidiol (CBD) Extract
Intervention Description
Cannabis is a well-known plant that contains more than 500 identified phytochemicals of which over 100 are cannabinoids. The most widely studied is 9-tetrahydrocannabinol (9-THC), which is the major psychoactive component of Cannabis, but Cannabidiol (CBD) has been increasingly favored for its reduced side effect profile and potential health benefits. CBD was first isolated from Cannabis in the 1940s. CBD, unlike 9-THC, does not bind to CB1 and CB2 receptors, which accounts for its lack of typical psychotropic effects, but is still appears to work via alternative mechanisms via the endocannabinoid system.
Intervention Type
Drug
Intervention Name(s)
Norethindrone Acetate
Intervention Description
Norethindrone is a form of progesterone, a female hormone important for regulating ovulation and menstruation.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
a substance or treatment which is designed to have no therapeutic value
Primary Outcome Measure Information:
Title
Pain Score
Description
Pain will be reported daily using the Visual Analog Scale, a 100mm horizontal line on which the patient's pain intensity is represented by a point between the extremities of 0 (no pain) and 100 (worst pain). The primary study endpoint will be compared between groups using the area under the curve.
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Change in Total FSFI Score
Description
The Female Sexual Function Index (FSFI) is a validated survey. The total FSFI score ranges from 2 (low sexual function) to 36 (high sexual function).
Time Frame
Baseline and 12 weeks
Title
Change in EHP-30 Core Domain
Description
The Endometriosis Health Profile-30 (EHP-30) is a validated questionnaire measuring quality of life in women with endometriosis. A summary score is calculated for the core domain on a scale of 0 to 100 (0 indicates the best possible health status whereas 100 indicates the worst possible health status).
Time Frame
Baseline and 12 weeks

10. Eligibility

Sex
Female
Gender Based
Yes
Gender Eligibility Description
Females ages 18-45 years at the time of enrollment who have a surgical diagnosis with direct visualization and/or histopathologic confirmation of endometriosis with associated moderate to severe endometriosis related pain
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Females ages 18-45 years at the time of enrollment A surgical diagnosis with direct visualization and/or histopathologic confirmation of endometriosis with associated moderate to severe endometriosis related pain ( > 3 on a VAS) Is not expected to undergo gynecological surgery or other surgical procedure for treatment of endometriosis during the study period Agrees to use approved contraception during the entire study if not surgically sterile Patients using oral contraceptives, vaginal ring, injectable progesterone and/or GnRH agonists/antagonist for contraception and/or management of endometriosis, can be included if both they and their primary provider agree to stopping their medication and transitioning to Norethindrone acetate (NETA) as the primary treatment of endometriosis throughout the study period. Patients using Long-acting reversible contraceptives (LARCs) for contraception and/or management of endometriosis can be included if both they and their primary provider agree to initiate Norethindrone (NETA) as the primary treatment of endometriosis throughout the study period Exclusion Criteria: Women that are pregnant, breastfeeding or trying to conceive Women with chronic daily opioid use and any chronic pain or frequently reoccurring pain condition, other than endometriosis, that is treated with opioids for > 14 days per month. Women that are currently using Cannabis based products or have used them within 30 days of enrollment Non-English speaking or inability to read and understand English Women with a BMI > 35 kg/m2 Women with known liver disease, such as hepatitis, or with screening LFTS (AST/ALT) > 3 times above the upper limits of normal (ULN) in the past year Women with chronic alcohol use (defined as > 3 drinks per day, averaged over one week) Women with chronic use of drugs (defined as > 10 days/month) that cause somnolence/sedation such as benzodiazepines or Central Nervous System (CNS) depressants that are unwilling or unable to discontinue the medications for the washout period and the duration of the study Women who are currently taking Clobazam or Valproate and are unwilling/unable to discontinue the medication for the washout period and the duration of the study Women with suicidal ideation or uncontrolled depression within the past year Known history of or suspected breast cancer on screening physical exam History of or active deep venous thrombosis or pulmonary embolism History of or active arterial thromboembolic event (e.g. stroke, myocardial infarction) Multiple (> 3) risk factors for arterial vascular disease (e.g. uncontrolled hypertension, diabetes mellitus, hypercholesterolemia, obesity and smoking) Current use of a progestin-containing contraceptive implant
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kristin Riley, MD
Phone
7175316446
Email
kriley1@pennstatehealth.psu.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Barbara Scheetz
Phone
717-531-4483
Email
bscheetz@pennstatehealth.psu.edu
Facility Information:
Facility Name
Penn State Health Milton S. Hershey Medical Center
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Heidi N Watts, BSN, RN
Phone
717-531-6272
Email
hwatts@pennstatehealth.psu.edu

12. IPD Sharing Statement

Plan to Share IPD
No
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Citation
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Links:
URL
http://www.fda.gov
Description
HIGHLIGHTS OF PRESCRIBING INFORMATION. EPIDIOLEX ® (cannabidi ol) oral solution, CX [pending DEA scheduling action] Initial U.S. Approval: XXXX [pending controlled substance scheduling]

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Cannabidiol and Management of Endometriosis Pain

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