Multiple Sclerosis Clinical Trial
Official title:
Effect of a Tissue Selective Estrogen Complex on Menopausal Symptoms in Women With MS: A Pilot Trial.
Duavee is a hormone receptor modulator that has been approved for the treatment of menopausal symptoms in menopausal women. The goal of this 8-week randomized, double blind, placebo controlled pilot study, is to determine whether this medication alleviates menopausal symptoms in women with MS. The investigators will secondarily determine whether addressing menopausal symptoms ameliorates MS symptoms and, on MRIs, is not triggering worsening inflammation.
Menopause in MS. Multiple sclerosis (MS) affects 3 times more women than men, and before age
50 in about 90% cases, i.e. prior to menopause. There is broad evidence for hormonal
regulation of MS in animal models and in clinical cohorts. Around menopause, many clinical
patients report symptom worsening associated with hot flashes, sleep disturbance or mood
changes. Additionally, individuals at MS may be at increased risk of developing osteoporosis.
Longer-term, an age-related decline in gonadal steroids might represent one sex-specific
influence on the known age-related increases in disability and conversion to progressive
course, which is marked by accelerated brain volume loss and neurodegeneration. Recent data
suggest that MS disease severity may worsen after menopause.
- Hormone therapy (HT). Despite the benefits of HT (menopausal symptoms, bone density),
very few women (<30% of our cohort) are currently taking HT for menopausal symptoms;
this is a result of risks such as (1) breast and endometrial cancer, and (2) stroke in
older women in the Women's Health Initiative. Recent data on HT use in MS (Nurses Health
Study) did not show any adverse effects on MS course, and women who used HT reported
better physical function than women who did not (Bove et al, Neurology 2016).
- Study Drug: Duavee, a tissue selective estrogen complex (TSEC), combines conjugated
estrogens (CE) with the selective estrogen receptor modulator (SERM) bazedoxifene (BZA).
BZA offsets estrogenic stimulation of endometrial and breast tissue, and CE 0.45mg/BZA
20mg is approved for menopausal symptom (hot flash) relief and osteoporosis prevention,
with a favorable tolerability and safety profile.
In the current study, 24 women with MS and who are experiencing bothersome menopause symptoms
will be enrolled and randomized to receive either 8 weeks of Duavee or 8 weeks of placebo.
Visits will be: eligibility, baseline, and 2 month visit.
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