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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT06067256
Other study ID # EFFI2021/01
Secondary ID
Status Recruiting
Phase Phase 4
First received
Last updated
Start date July 20, 2023
Est. completion date June 2024

Study information

Verified date September 2023
Source Italfarmaco
Contact Roberto Piazza, MD
Phone +39 0264432516
Email r.piazza@italfarmaco.com
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

As there are no recent studies conducted in Italy on the profile of this COC, the purpose of this study is to evaluate its efficacy and tolerability in a given subset of women residing in Italy that are in need of contraception. Evaluate the cycle control: breakthrough bleeding (bleeding and/or spotting between cyclically regular onset of menses) of monophasic oral contraceptive pill Effimia® (NGM250 + EE35) in a population of women residing in Italy.


Recruitment information / eligibility

Status Recruiting
Enrollment 228
Est. completion date June 2024
Est. primary completion date December 2023
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years to 35 Years
Eligibility Inclusion Criteria: - All the following criteria must be met. - Healthy women aged between 18 and 35 years (inclusive) in need of contraception. - Subjects residing in Italy and having a good knowledge of the Italian language, such as to correctly understand the Informed Consent Form, the instructions for use, and to ensure potential adhesion to the study. - Subjects providing written Informed Consent Form. - Subjects willing to comply with the study protocol. Exclusion Criteria: - Subjects who meet even one of the following criteria will be excluded from the study. - Subjects presenting any contraindications to the use of Combined Oral Contraceptives (COC) according to the current Summary of Product Characteristics (SmPC) of Effimia®, i.e. subjects presenting (or have ever presented) myocardial infarction, transient ischemic attack (TIA), stroke, angina pectoris, deep vein thrombosis (DVT), pulmonary embolism (PE) (or presence of blood clot in other organs than legs and lungs), any blood clotting disorder (such as protein C deficiency, protein S deficiency, antithrombin-III deficiency), or subjects that need to undergo surgery or that have to lie down for a long period of time (including the risk of previous deep vein thrombosis (DVT), arterial thromboembolism (ATE), hypertension in course of treatment and diabetes). If any of the listed conditions should appear during the use of the tested COC, the product must be stopped immediately, and the subject withdrawn from the study. - Subjects presenting severe diabetes with blood vessel damages, heart valve disease with complications, severe hypertension, severe hypercholesterolemia, or hypertriglyceridemia, hyperhomocysteinaemia, migraine with aura, hepatitis C (and taking medications for this condition), endometrial hyperplasia, unexplained vaginal bleeding, that are breastfeeding or pregnant or that are suspecting a pregnancy. - Subjects presenting (or have ever presented) any liver disease not yet recovered (liver function not yet normalized), any benign or malignant tumour of the liver, any breast or genital organs cancer (even suspected), jaundice during pregnancy or while using hormonal contraceptives. - Subjects presenting galactose intolerance, total lactase deficiency or glucosegalactose malabsorption syndrome. - Subjects presenting hypersensitivity to the active substances or to any excipients of the tested COC (e.g., norgestimate, ethinylstradiol or lactose). - Subjects using the following not allowed treatments during the whole study period (according to the SmPC of the Investigational Medicinal Product - IMP): treatments for tuberculosis (e.g. rifampicin), for epilepsy (e.g. primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine), for HIV and hepatitis C virus infection (protease inhibitor drugs and non-nucleoside reverse transcriptase inhibitors such as ritonavir, nevirapine, efavirenz and also ombitasvir, paritaprevir, ritonavir and dasabuvir), for fungal infections (e.g. griseofulvin), for arthritis, for osteoarthritis (etoricoxib ), for pulmonary arterial hypertension (bosentan) and St. John's wort used as an antidepressant. Medicines containing cyclosporine, the antiepileptic lamotrigine, tranexamic acid, theophylline (used to treat respiratory problems) and tizanidine (used to treat muscle pain and / or cramps) should not be taken as well. - Subjects who have used hormonal contraceptives in the previous month. - Subjects presenting a Body Mass Index - BMI = 30 kg/m2 (class I obesity). - Subjects smoking > 15 cigarettes per day. - Subjects using COC off-label (e.g., for polycystic ovarian syndrome - PCOS, endometriosis, or recurrent menometrorrhagia). - Subjects currently taking part or who took part in clinical studies with experimental products in the previous month. - Subjects showing incapacity / inability to comply with the study protocol (unreliability in the intake of the product or in the completion of the diary) according to the Investigator's opinion.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Female Contraceptive
Effimia® exerts its action by means of a gonadotropin suppression mechanism through the estrogenic and progestin action exerted by EE and NGM. The contraceptive effect of Effimia® is based on the interaction of various factors, the most important of which consist of ovulation inhibition and endometrial modifications.

Locations

Country Name City State
Italy IRCCS Ospedale Policlinico San Martino Genova

Sponsors (1)

Lead Sponsor Collaborator
Italfarmaco

Country where clinical trial is conducted

Italy, 

References & Publications (33)

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European Medicines Agency Benefits of combined hormonal contraceptives (CHCs) continue to outweigh risks - CHMP endorses PRAC recommendation EMA/709120/2013 Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/11/news_d etail_001969.jsp&mid=WC0b01ac058004d5c1

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Farnè, M., Sebellico, A., Gnugnoli, D., & Corallo, A. (1991). POMS: Profile Of Mood States. Adattamento italiano [POMS: Profile Of Mood States. Italian Adaptation]. Firenze, Italy: Organizzazioni Speciali.

Filocamo MT, Serati M, Li Marzi V, Costantini E, Milanesi M, Pietropaolo A, Polledro P, Gentile B, Maruccia S, Fornia S, Lauri I, Alei R, Arcangeli P, Sighinolfi MC, Manassero F, Andretta E, Palazzetti A, Bertelli E, Del Popolo G, Villari D. The Female Sexual Function Index (FSFI): linguistic validation of the Italian version. J Sex Med. 2014 Feb;11(2):447-53. doi: 10.1111/jsm.12389. Epub 2013 Nov 13. — View Citation

Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011 Sep;29(5):383-90. doi: 10.1055/s-0031-1287662. Epub 2011 Nov 7. — View Citation

Fraser IS, Critchley HO, Munro MG, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? Hum Reprod. 2007 Mar;22(3):635-43. doi: 10.1093/humrep/del478. Epub 2007 Jan 4. — View Citation

Fraser IS, Critchley HO, Munro MG, Broder M; Writing Group for this Menstrual Agreement Process. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007 Mar;87(3):466-76. doi: 10.1016/j.fertnstert.2007.01.023. Erratum In: Fertil Steril. 2007 Aug;88(2):538. — View Citation

Gallo MF, Nanda K, Grimes DA, Lopez LM, Schulz KF. 20 microg versus >20 microg estrogen combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013 Aug 1;2013(8):CD003989. doi: 10.1002/14651858.CD003989.pub5. — View Citation

Ghooi RB, Bhosale N, Wadhwani R, Divate P, Divate U. Assessment and classification of protocol deviations. Perspect Clin Res. 2016 Jul-Sep;7(3):132-6. doi: 10.4103/2229-3485.184817. — View Citation

Goldzieher JW. Selected aspects of the pharmacokinetics and metabolism of ethinyl estrogens and their clinical implications. Am J Obstet Gynecol. 1990 Jul;163(1 Pt 2):318-22. doi: 10.1016/0002-9378(90)90575-r. — View Citation

Mannarini, S., Polimeni, S., Shams, M., & Giacobbo, M. (2012). Assessing negative and positive mood states: The identification of a short form of the POMS scale in Italian oncology outpatients. TPM - Testing, Psychometrics, Methodology in Applied Psychology, 19(2), 135- 145. https://doi.org/10.4473/TPM19.2.5

McNair DM et al. Manual for the profile of Mood States. Toronto, ON, Multi-Health Systems Inc.1992.

McNair, D. M., Lorr, M., & Droppleman, L. (1971/1981). Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.

McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Services.

Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ. Use of contraception and use of family planning services in the United States: 1982-2002. Adv Data. 2004 Dec 10;(350):1-36. — View Citation

National Research Council (US) Committee on Population. Contraception and Reproduction: Health Consequences for Women and Children in the Developing World. Washington (DC): National Academies Press (US); 1989. Available from http://www.ncbi.nlm.nih.gov/books/NBK235072/ — View Citation

PASS 2021 Power Analysis and Sample Size Software (2021). NCSS, LLC. Kaysville, Utah, USA, ncss.com/software/pass

Phillips A, Hahn DW, McGuire JL. Preclinical evaluation of norgestimate, a progestin with minimal androgenic activity. Am J Obstet Gynecol. 1992 Oct;167(4 Pt 2):1191-6. doi: 10.1016/s0002-9378(12)90410-x. — View Citation

Rapkin Andrea, L. H. Chang & A. E. Reading (1987) Premenstrual syndrome: a double blind placebo controlled study of treatment with progesterone vaginal suppositories, Journal of Obstetrics and Gynaecology, 7:3, 217-220, DOI: 10.3109/01443618709068522

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R Jr. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000 Apr-Jun;26(2):191-208. doi: 10.1080/009262300278597. — View Citation

Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab. 2007 Feb;92(2):405-13. doi: 10.1210/jc.2006-1864. Epub 2006 Nov 7. — View Citation

Runnebaum B, Grunwald K, Rabe T. The efficacy and tolerability of norgestimate/ethinyl estradiol (250 micrograms of norgestimate/35 micrograms of ethinyl estradiol): results of an open, multicenter study of 59,701 women. Am J Obstet Gynecol. 1992 Jun;166(6 Pt 2):1963-8. doi: 10.1016/0002-9378(92)91396-r. — View Citation

Sitruk-Ware R, Nath A. Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills. Best Pract Res Clin Endocrinol Metab. 2013 Feb;27(1):13-24. doi: 10.1016/j.beem.2012.09.004. Epub 2012 Oct 10. — View Citation

Trussell J. Contraceptive failure in the United States. Contraception. 2011 May;83(5):397-404. doi: 10.1016/j.contraception.2011.01.021. Epub 2011 Mar 12. — View Citation

Van Vliet HA, Raps M, Lopez LM, Helmerhorst FM. Quadriphasic versus monophasic oral contraceptives for contraception. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD009038. doi: 10.1002/14651858.CD009038.pub2. — View Citation

Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005 Jan-Feb;31(1):1-20. doi: 10.1080/00926230590475206. — View Citation

Wyatt K, Dimmock P, Jones P, Obhrai M, O'Brien S. Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review. BMJ. 2001 Oct 6;323(7316):776-80. doi: 10.1136/bmj.323.7316.776. — View Citation

* Note: There are 33 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Cycle control evaluation parameter breakthrough bleeding (bleeding and/or spotting between cyclically regular onset of menses) by calculating the intermenstrual spotting occurrence rate at sixth cycle only (value to be intended as not cumulative with values from the other 5 cycles taking place during the whole study period). A comparison within group will be performed at V3 with respect to Baseline (V1) 180 days
Secondary Cycle control evaluation parameters frequency, duration, regularity, flow volume (subject determined), unscheduled bleeding. A comparison within group will be performed at V2 and V3 with respect to Baseline (V1). 180 days
Secondary Global Acne Grading System (GAGS). A comparison within group will be performed at V2 and V3 with respect to Baseline (V1). 180 days
Secondary Profile of Mood State (POMS). A comparison within group will be performed at V2 and V3 with respect to Baseline (V1). 180 days
Secondary Female Sexual Function Index (FSFI). A comparison within group will be performed at V2 and V3 with respect to Baseline (V1). 180 days
Secondary Dysmenorrhea - VAS scale. A comparison within group will be performed at V2 and V3 with respect to Baseline (V1) 180 days
Secondary Compliance Adherence to treatment 180 days
Secondary Contraception failure rate during the 6-month treatment the contraception failure rate is defined as the proportion of women who will become pregnant during the study period. The reasons for any contraception failure occurrence will be identified and listed (e.g., discontinuation or poor compliance). 180 days
Secondary Metabolic and hormonal parameters blood lipid and glucose parameters (total cholesterol, High Density Lipoprotein - Cholesterol HDL-C, Low Density Lipoprotein - Cholesterol LDL-C, triglycerides, total testosterone, dehydroepiandrosterone - DHEAS, androstenedione, glucose, insulin, Sex Hormone Binding Globulin - SHBG) and hyperandrogenism (Free Androgenicity Index - FAI) - only in a subgroup of 28 subjects recruited only in the centre of Genova. They will be evaluated in comparison with Baseline (V1). 180 days
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