Clinical Trials Logo

Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT06055192
Other study ID # OPEFF/0122/SU
Secondary ID
Status Not yet recruiting
Phase
First received
Last updated
Start date September 2023
Est. completion date October 2024

Study information

Verified date September 2023
Source Effik SA
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The latest data on the prevalence of nausea in pregnancy in Switzerland is dated 2015 but has been hypothesised that the recent introduction on the market of new drugs against this symptom could modify its epidemiology. For this reason, we have planned the present survey, calculating an adequate sample size of Swiss pregnant women (the population of interest) and, according to a cross-sectional design, planning the collection of response variables with the aim of estimating the prevalence of burden and nausea and vomiting in pregnancy


Description:

Nausea with or without vomiting (Nausea and Vomiting in Pregnancy - NVP) in early pregnancy (before 9 and up to 16 weeks of gestation) is very common (50-80%); these symptoms rarely persist throughout pregnancy (10-20%). Even if NVP aetiology remains unknown, the cause is most likely multifactorial NVP severity can be assessed with the validated, 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) Scale. Management and treatment of NVP focus on reducing symptoms, improving quality of life, preventing serious complications, and minimising foetal effects of maternal pharmacologic treatment. It is advised to follow dietary and lifestyle recommendations, followed by available alternative and pharmacological treatments. Swissmedic has recently approved doxylamine as a drug for the treatment of NVP symptoms in combination with pyridoxine (Cariban®, Effik SA, Switzerland). Its efficacy and safety have been widely studied. A 2014 data re-analysis of a previous meta-analysis took into account a total of 139414 women in reports about the safety of antihistamines and 129108 in reports about the safety of doxylamine. In these studies, 23485 women were exposed to antihistamines and 14624 were exposed to doxylamine. Neither increased foetal risk for congenital malformations nor other adverse pregnancy outcomes were demonstrated. The safety of the drug is additionally supported by extensive international literature. Moreover, a recent study showed that Cariban® behaves as a prolonged-release formulation, which correlates with rapid absorption and arising of the actives in the plasma, but also long-lasting and sustained bioavailability, especially when administered following the complete posology. These results would underlie its demonstrated efficacy to relieve nausea and vomiting of pregnancy (NVP) under clinical settings. The exposure to doxylamine-pyridoxine in pregnancy (or to the combination of doxylamine and pyridoxine) is classified as safe, and its use is recommended as first-line therapy of nausea and vomiting in pregnancy by the American College of Obstetricians and Gynaecologists (ACOG) Guidelines, by the Society of Obstetricians and Gynecologists of Canada and organizations such as Mother to Baby (formerly known as Organization of Teratogen Information Services. An epidemiological study, published in 2015, stated that the prevalence of nausea in Switzerland was 70,6%. It is to be noted that women who reported nausea also had a high burden of co-morbidity, especially heartburn and reflux symptoms and an association of NPV with symptoms of depression and sick leave was shown. It is possible that the recent introduction of an association of doxylamine succinate 10 mg and pyridoxine hydrochloride 10 mg (Cariban®, Effik SA Switzerland) on the Swiss market and the recent publication of the SGGG Expert letter on NVP and hyperemesis gravidarum (1) could have had a substantial impact on the extent of this disturbance, the awareness of the therapists and the perception of the women. In this context, a Survey will be carried out. A Survey is a procedure which, through a scientific method of detection (a questionnaire to be submitted to a representative sample of subjects related to the issue of the research) allows to collect, and subsequently to analyse, the data to study the relationships between different variables would yield significant scientific results. The objectives of the study are: Evaluate the prevalence and burden that the symptoms of nausea and vomiting have in pregnant women in Switzerland. The following outcomes will be evaluated: - Demographic data (including ethnicity: Caucasian, African, Asian, or Other). - NVP prevalence. - Percentage of mild, medium, and severe cases based on PUQE-24. - Percentage of answer allocation to NVP related questions. - Onset for each symptom and its duration. - Correlations between demographic data (age, first pregnancy status, multiparity, geographical origin, kinds of work and educational qualification) and the presence of symptoms and their severity. - Correlation of the above-mentioned parameters with the use of non-pharmacological, pharmacological or both therapies. - Analysis of drug therapies, of their correlation with the severity of the symptoms during pregnancy and with the possible outcomes of the same. - Correlation between the severity of the symptoms and the consequences on the woman's personal life (family, work, etc.). - Number of cases with hospitalization in relation to total and severity of symptoms (PUQE-24). - Correlation between symptoms in pregnancy and outcomes based on data from the post pregnancy questionnaire (weight of the new-born, gestational age at birth and any complications).


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 200
Est. completion date October 2024
Est. primary completion date July 2024
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria: Subjects will be eligible for inclusion if all the following criteria are respected: - Women aged = 18 years. - Women in physiological pregnancy and between the 18th and 22nd week of pregnancy (at time of morphological ultrasound). - Women able to communicate adequately with the Investigator and able to read, understand and provide the answers required by the questionnaires in one of the languages in which they will be provided (Italian, German, French or English). - Women able to understand and who can provide valid informed consent to the Survey. Exclusion Criteria: - Subjects fulfilling one or more of the following exclusion criteria will not be included in the study: - Twin pregnancy. - Medically assisted procreation (MAP).

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Survey
Survey

Locations

Country Name City State
n/a

Sponsors (2)

Lead Sponsor Collaborator
Effik SA Opera CRO, a TIGERMED Group Company

References & Publications (42)

APGO. APGO. Nausea and vomiting of pregnancy. APGO Educational series on women's health issues. Boston: Jespersen & Associates, LLC; 2013. 2013.

Arsenault MY, Lane CA, MacKinnon CJ, Bartellas E, Cargill YM, Klein MC, Martel MJ, Sprague AE, Wilson AK. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Can. 2002 Oct;24(10):817-31; quiz 832-3. English, French. — View Citation

Berard A, Sheehy O, Gorgui J, Zhao JP, Soares de Moura C, Bernatsky S. New evidence for concern over the risk of birth defects from medications for nausea and vomitting of pregnancy. J Clin Epidemiol. 2019 Dec;116:39-48. doi: 10.1016/j.jclinepi.2019.07.014. Epub 2019 Jul 26. — View Citation

Biffi A, Rea F, Locatelli A, Cetin I, Filippelli A, Corrao G. Misleading meta-analyses of observational studies may generate unjustified alarms: The case of medications for nausea and vomiting in pregnancy. Pharmacol Res. 2021 Jan;163:105229. doi: 10.1016/j.phrs.2020.105229. Epub 2020 Oct 5. — View Citation

Brent RL. Bendectin: review of the medical literature of a comprehensively studied human nonteratogen and the most prevalent tortogen-litigen. Reprod Toxicol. 1995 Jul-Aug;9(4):337-49. doi: 10.1016/0890-6238(95)00020-b. — View Citation

Brott NR, Reddivari AKR. Doxylamine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551646/

Chin JW, Gregor S, Persaud N. Re-analysis of safety data supporting doxylamine use for nausea and vomiting of pregnancy. Am J Perinatol. 2014 Sep;31(8):701-10. doi: 10.1055/s-0033-1358772. Epub 2013 Dec 9. — View Citation

Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018 Jan;131(1):e15-e30. doi: 10.1097/AOG.0000000000002456. — View Citation

de Tejada BM, Vonzun L, Mandach DUV, Burch A, Yaron M, Hodel M, et al. Nausea and Vomiting of Pregnancy, Hyperemesis gravidarum. :5.

Doxylamine/pyridoxine for nausea and vomiting in pregnancy. Drug Ther Bull. 2019 Mar;57(3):38-41. doi: 10.1136/dtb.2018.000053. Epub 2019 Jan 31. No abstract available. — View Citation

Ebrahimi N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) scale. J Obstet Gynaecol Can. 2009 Sep;31(9):803-807. doi: 10.1016/S1701-2163(16)34298-0. — View Citation

Einarson TR, Leeder JS, Koren G. A method for meta-analysis of epidemiological studies. Drug Intell Clin Pharm. 1988 Oct;22(10):813-24. doi: 10.1177/106002808802201021. — View Citation

fedlex-data-admin-ch-eli-cc-2013-643-20140101-en-pdf-a.pdf [Internet]. [cited 2022 Jun 13]. Available from: https://fedlex.data.admin.ch/filestore/fedlex.data.admin.ch/eli/cc/2013/643/20140101/en/pdf-a/fedlex-data-admin-ch-eli-cc-2013-643-20140101-en-pdf-a.pdf

Fejzo MS, Trovik J, Grooten IJ, Sridharan K, Roseboom TJ, Vikanes A, Painter RC, Mullin PM. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers. 2019 Sep 12;5(1):62. doi: 10.1038/s41572-019-0110-3. — View Citation

Gilboa SM, Ailes EC, Rai RP, Anderson JA, Honein MA. Antihistamines and birth defects: a systematic review of the literature. Expert Opin Drug Saf. 2014 Dec;13(12):1667-98. doi: 10.1517/14740338.2014.970164. Epub 2014 Oct 11. — View Citation

Heitmann K, Holst L, Lupattelli A, Maltepe C, Nordeng H. Treatment of nausea in pregnancy: a cross-sectional multinational web-based study of pregnant women and new mothers. BMC Pregnancy Childbirth. 2015 Dec 1;15:321. doi: 10.1186/s12884-015-0746-2. — View Citation

Heitmann K, Nordeng H, Havnen GC, Solheimsnes A, Holst L. The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again - results from a cross-sectional study. BMC Pregnancy Childbirth. 2017 Feb 28;17(1):75. doi: 10.1186/s12884-017-1249-0. — View Citation

Heitmann K, Solheimsnes A, Havnen GC, Nordeng H, Holst L. Treatment of nausea and vomiting during pregnancy -a cross-sectional study among 712 Norwegian women. Eur J Clin Pharmacol. 2016 May;72(5):593-604. doi: 10.1007/s00228-016-2012-6. Epub 2016 Jan 27. — View Citation

Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2002 May;186(5 Suppl Understanding):S228-31. doi: 10.1067/mob.2002.123054. — View Citation

Koren G, Clark S, Hankins GD, Caritis SN, Miodovnik M, Umans JG, Mattison DR. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J Obstet Gynecol. 2010 Dec;203(6):571.e1-7. doi: 10.1016/j.ajog.2010.07.030. Epub 2010 Sep 16. — View Citation

Koren G, Cohen R. Measuring the severity of nausea and vomiting of pregnancy; a 20-year perspective on the use of the pregnancy-unique quantification of emesis (PUQE). J Obstet Gynaecol. 2021 Apr;41(3):335-339. doi: 10.1080/01443615.2020.1787968. Epub 2020 Aug 19. — View Citation

Koren G. Safety considerations surrounding use of treatment options for nausea and vomiting in pregnancy. Expert Opin Drug Saf. 2017 Nov;16(11):1227-1234. doi: 10.1080/14740338.2017.1361403. Epub 2017 Aug 9. — View Citation

Lee J, Einarson A, Gallo M, Okotore B, Koren G. Longitudinal change in the treatment of nausea and vomiting of pregnancy in Ontario. Can J Clin Pharmacol. 2000 Winter;7(4):205-8. — View Citation

Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011 Jun;40(2):309-34, vii. doi: 10.1016/j.gtc.2011.03.009. — View Citation

London V, Grube S, Sherer DM, Abulafia O. Hyperemesis Gravidarum: A Review of Recent Literature. Pharmacology. 2017;100(3-4):161-171. doi: 10.1159/000477853. Epub 2017 Jun 23. — View Citation

Madjunkova S, Maltepe C, Koren G. The delayed-release combination of doxylamine and pyridoxine (Diclegis(R)/Diclectin (R)) for the treatment of nausea and vomiting of pregnancy. Paediatr Drugs. 2014 Jun;16(3):199-211. doi: 10.1007/s40272-014-0065-5. — View Citation

Madjunkova S, Maltepe C, Koren G. The Leading Concerns of American Women with Nausea and Vomiting of Pregnancy Calling Motherisk NVP Helpline. Obstet Gynecol Int. 2013;2013:752980. doi: 10.1155/2013/752980. Epub 2013 Apr 15. — View Citation

McKeigue PM, Lamm SH, Linn S, Kutcher JS. Bendectin and birth defects: I. A meta-analysis of the epidemiologic studies. Teratology. 1994 Jul;50(1):27-37. doi: 10.1002/tera.1420500105. — View Citation

McParlin C, O'Donnell A, Robson SC, Beyer F, Moloney E, Bryant A, Bradley J, Muirhead CR, Nelson-Piercy C, Newbury-Birch D, Norman J, Shaw C, Simpson E, Swallow B, Yates L, Vale L. Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review. JAMA. 2016 Oct 4;316(13):1392-1401. doi: 10.1001/jama.2016.14337. — View Citation

Nausea and Vomiting of Pregnancy (NVP). 2022;

Neutel CI, Johansen HL. Measuring drug effectiveness by default: the case of Bendectin. Can J Public Health. 1995 Jan-Feb;86(1):66-70. — View Citation

Nuangchamnong N, Niebyl J. Doxylamine succinate-pyridoxine hydrochloride (Diclegis) for the management of nausea and vomiting in pregnancy: an overview. Int J Womens Health. 2014 Apr 12;6:401-9. doi: 10.2147/IJWH.S46653. eCollection 2014. — View Citation

Office FS. Births [Internet]. [cited 2022 Jun 14]. Available from: https://www.bfs.admin.ch/bfs/en/home/statistiken/bevoelkerung/geburten-todesfaelle/geburten.html

Persaud N, Chin J, Walker M. Should doxylamine-pyridoxine be used for nausea and vomiting of pregnancy? J Obstet Gynaecol Can. 2014 Apr;36(4):343-348. doi: 10.1016/S1701-2163(15)30611-3. — View Citation

Rubenfeld GD. Surveys: an introduction. Respir Care. 2004 Oct;49(10):1181-5. — View Citation

Safdar N, Abbo LM, Knobloch MJ, Seo SK. Research Methods in Healthcare Epidemiology: Survey and Qualitative Research. Infect Control Hosp Epidemiol. 2016 Nov;37(11):1272-1277. doi: 10.1017/ice.2016.171. Epub 2016 Aug 12. — View Citation

Saz-Leal P, Zamorano-Dominguez L, Frias J, Guerra P, Saura-Valls M, Roca-Juanes R, Nebot-Troyano J, Garcia-Aguilar E, Vilchez T, Urso K. Bioavailability of Cariban(R) Capsules: A Modified-Release Fixed-Dose Combination of Doxylamine and Pyridoxine to Relieve Nausea and Vomiting During Pregnancy. Drugs R D. 2023 Jun;23(2):185-195. doi: 10.1007/s40268-023-00425-7. Epub 2023 Jun 15. — View Citation

Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta-analysis. Am J Perinatol. 1997 Mar;14(3):119-24. doi: 10.1055/s-2007-994110. — View Citation

Smolina K, Hanley GE, Mintzes B, Oberlander TF, Morgan S. Trends and Determinants of Prescription Drug Use during Pregnancy and Postpartum in British Columbia, 2002-2011: A Population-Based Cohort Study. PLoS One. 2015 May 26;10(5):e0128312. doi: 10.1371/journal.pone.0128312. eCollection 2015. — View Citation

SR 810.301 - Ordinance of 20 September 2013 on Human Research with the Exception of Clinical Trials (Human Research Ordinance, HRO) [Internet]. [cited 2022 Jun 13]. Available from: https://www.fedlex.admin.ch/eli/cc/2013/642/en

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9. doi: 10.1016/j.jclinepi.2007.11.008. — View Citation

WMA - The World Medical Association-WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2022 Jun 13]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/

* Note: There are 42 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Primary Outcome Measure Evaluate the prevalence and burden that the symptoms of nausea and vomiting have in pregnant women in Switzerland 185 days
Secondary Secondary Outcome Measure demographic data (including ethnicity: Caucasian, African, Asian or Other). 185 days
Secondary Secondary Outcome Measure NVP prevalence 185 days
Secondary Secondary Outcome Measure Percentage of mild, medium, and severe cases based on PUQE-24. 185 days
Secondary Secondary Outcome Measure Percentage of answer allocation to NVP related questions 185 days
Secondary Secondary Outcome Measure Onset for each symptom and its duration 185 days
Secondary Secondary Outcome Measure Correlations between demographic data (age, first pregnancy status, multiparity, geographical origin, kinds of work and educational qualification) and the presence of symptoms and their severity. 185 days
Secondary Secondary Outcome Measure Correlation of the above-mentioned parameters with the use of non-pharmacological, pharmacological (e.g., Cariban®) or both therapies. 185 days
Secondary Secondary Outcome Measure Analysis of drug therapies, their correlation with the severity of the symptoms during pregnancy and with the possible outcomes of the same 185 days
Secondary Secondary Outcome Measure Correlation between the severity of the symptoms and the consequences on the woman's personal life (family, work, etc.). 185 days
Secondary Secondary Outcome Measure Number of cases with hospitalization in relation to total and severity of symptoms (PUQE-24). 185 days
Secondary Secondary Outcome Measure Correlation between symptoms in pregnancy and outcomes based on data from the post pregnancy questionnaire (weight of the new-born, gestational age at birth and any complications). 185 days
See also
  Status Clinical Trial Phase
Terminated NCT01649258 - Fosaprepitant Dimeglumine and Granisetron Transdermal System in Preventing Nausea and Vomiting in Patients With Breast Cancer Undergoing Chemotherapy Phase 1
Completed NCT02939287 - Aprepitant- and Olanzapine- Containing Anti-emetic Regimens With High Dose Melphalan Phase 3
Recruiting NCT04091789 - Sublingual Tablets With Cannabinoid Combinations for the Treatment of Dysmenorrhea Phase 2
Completed NCT02462811 - A Double-Blind, Randomized, Active- and Placebo-Controlled, Multiple-Dose Multi-Center Phase 3 Study of the Safety and Efficacy of CL-108 in the Treatment of Moderate to Severe Acute Pain and Opioid-Induced Nausea and Vomiting (OINV) Phase 3
Completed NCT01007500 - Effect of Dexamethasone Combined With Ondansetron on Postoperative Nausea and Vomiting in Patients With Patient-controlled Analgesia After Video-assisted Thoracoscopic Surgery Phase 4
Recruiting NCT00528554 - Laser Acupuncture Against Nausea in Children N/A
Completed NCT00537875 - Evaluation of the Effect of Zingiber Officinalis on Nausea and Vomiting in Patients Receiving Cisplatin Based Regimens N/A
Completed NCT00394966 - A Multicenter, Randomized, Controlled Trial of SCH 619734 for the Treatment of Chemotherapy-Induced Nausea and Vomiting (Study P04351AM2)(COMPLETED) Phase 2
Completed NCT00946387 - To Demonstrate the Relative Bioavailability Study of Ondansetron HCl 24 mg Tablets Under Fasting Conditions Phase 1
Completed NCT00947128 - To Demonstrate the Relative Bioavailability Study of Ondansetron HCl 24 mg Tablets Under Non-Fasting Conditions Phase 1
Recruiting NCT05433636 - Mindful Waiting Room N/A
Not yet recruiting NCT04827108 - Psychometric Properties of the Chinese Version of PeNAT
Not yet recruiting NCT04853303 - VR to Improve CINV, Sleep and Pain Among Children With Cancer in HK N/A
Terminated NCT04247100 - A Study of Randomized Sham-control Auricular TENS Unit Stimulation in Pediatric Functional Gastrointestinal Disorders N/A
Recruiting NCT04181346 - Pregabalin for the Prevention of Chemotherapy Induced Nausea and Vomiting Phase 2
Recruiting NCT03679182 - Efficacy and Safety of Olanzapine for the Treatment of Nausea and Vomiting in Palliative Cancer Care Phase 2
Completed NCT02618343 - EMS Use of Isopropyl Alcohol Aromatherapy Versus Ondansetron N/A
Terminated NCT01405924 - Fosaprepitant (MK-0517, EMEND® IV) In Salvage Treatment of Chemotherapy-Induced Vomiting (MK-0517-030) Phase 2
Recruiting NCT04116697 - A Randomized Controlled Trial to Evaluate the Efficacy of Acupuncture Versus Aromatherapy as Treatments to Lessen Nausea, Vomiting and Anxiety Associated With Adriamycin and Cytoxan N/A
Completed NCT02787707 - Effect of Iranian Traditional Medicine Remedy on Chemotherapy Induced Nausea and Vomiting Phase 2