WHAT IS THE STUDY PRODUCT? The study product is a contraceptive patch, which has the study drug on the patch. The patch is applied directly to the skin and it contains Levonorgestrel (LNG) in a time-release form. LNG is a hormone that has been tested and been approved by the Food \& Drug Administration (FDA) in other forms, for example: contraceptive pills, intrauterine devices (IUDs, which are put in the uterus (womb)) and implants (drug in silicon tubing placed under the skin). The use of LNG in the form of a contraceptive patch makes this an experimental drug because the way the drug will be absorbed in the body is a new technique. This study drug does not contain estrogen and it does not protect against HIV, AIDS, or any other sexually transmitted diseases (STDs). LNG is a progestin (a type of drug that is like a hormone. Progestins can cause changes at the opening of the uterus (womb), such as thickening of the cervical mucus (fluid). This thickened cervical mucus makes it difficult for the male's sperm to reach and fertilize the woman's egg. Since LNG is being absorbed through your skin from the patch, it is experimental, and it is unknown if this study product will really prevent pregnancy like other progestins. WHY IS THIS STUDY BEING DONE? The purpose of this study is to find out: * How well the patch prevents pregnancy * How safe the patch is to use every day * How much study drug needs to be in the patch to make sure that it prevents pregnancy * How the study drug in the patch affects cervical mucus (fluids) * How the study drug in the patch affects your rate of ovulation (how often you release an egg) * How well the patch sticks to your skin, without falling off, for a week at a time * Whether the patch causes any skin irritation or rash (redness or itchiness) * Whether the study drug in the patch affects your everyday life and if it causes any side effects. WHAT DOES THE STUDY INVOLVE? We expect that there will be approximately twenty (20) women at each of the six (6) participating clinics in the study. In total, there will be about 120 women from all over the United States who will be in this study. This study is comparing the effectiveness of two different doses of the study drug (40ug and 75 ug) in the patches. This study is an open-label randomized trial, meaning that you and your study doctor will be aware of the dosage of study drug that you will be given. Randomization means that you will be selected by chance, like tossing a coin or rolling a dice. You have a 50% chance of being in the group that receives the 40ug dose patch or the group that receives 75ug dose patch.
This is a Phase I/II, multi-center, open-label, randomized, parallel group, pharmacokinetic, pharmacodynamic study of the AG1000-6.5 and AG1000-12.5 transdermal contraceptive delivery systems (TCDS) in healthy women followed as an outpatient for up to three 28-day cycles (12 weeks or approximately 3 months). During this study, subjects will receive active treatment with the LNG TCDS patches for 11 weeks, followed by one week of post-treatment assessment. The TCDS is designed for one week of patch wear. This study will be conducted by the National Institute of Child Health and Human Development (NICHD) in its Contraceptive Clinical Trials Network (CCTN) at 6 sites in the USA and will enroll approximately 120 women. This study will enroll approximately 120 subjects, who will be randomized across all sites into the two treatment groups (\~60 subjects at each dose level). The randomization schedule will be further stratified to ensure enrollment of approximately 50% of subjects with BMI \>32 kg/m2 and \<40 kg/m2 and approximately 50% of subjects with BMI \<32 kg/m2 for each dose level.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
121
6.5mg patch daily for 11 weeks
6.5mg patch daily for 11 weeks
12.5mg patch daily for 11 weeks
12.5mg patch daily for 11 weeks
University of Colorado - Adv. Repro. Med.
Aurora, Colorado, United States
Columbia University
New York, New York, United States
University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
Oregon Health Sciences University
Portland, Oregon, United States
University of Pennsylvania Medical Center
Philadelphia, Pennsylvania, United States
Magee-Womens Hospital
Pittsburgh, Pennsylvania, United States
Number of Subjects With Poor Cervical Mucus Scores During Treatment Period
The primary endpoint is a subject's incidence of the "Poor" cervical mucus score as determined by the modified Insler score. The cervical mucus score will be based on the modified Insler scoring system (the volume and pH of the mucus are not included in the total scoring) yielding a total possible modified Insler cervical mucus score of 12 (3, 4). The total modified Insler cervical mucus scores of 0-4, 5-8 and 9-12 will be categorized as "Poor," "Fair" and "Good," respectively.
Time frame: Visit 1 (Treatment Day 1) through Visit 19 (Treatment Day 79)
Changes From Baseline in Endometrial Thickness
Changes from Baseline in endometrial thickness measured at Visit 1, Visits 3-5, Visits 7-10, Visit 12-18 (Days 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78)
Time frame: Days 0, 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, up to 78 days
Patch Wearability Based on Patch Adhesion
Patch wearability measured by patch adhesion at Visit 4, Visit 6, Visit 8, Visit 10, Visits 12-18 (Days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78) based on the following criteria: \> 90% = \> 90% of patch adhered (no lift from skin); \>75% but \< 90% = \> 75% adhered but \< 90% (some edges showing lift from skin); \> 50% but \< 75% = \> 50% adhered but \< 75% (half of patch lifts of skin; \< 50% = \< 50% adherence ( \> half of patch lifts off, but not detached); Patch Off = patch completely detached from skin
Time frame: Days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78, up to 78 days
LNG PK Profiles After the First and Fifth Patches Are Applied and After the Eleventh (Last) Patch is Removed
LNG PK at 0, 1, 2, 4, and 6 hours with patch on Day 1 (Visit 1), Day 29 (Visit 5), and Day 78 (Visit 12) after patch removal using Area Under the Curve Mean at each visit. The mean area under the curve represents the amount of LNG in the body at the given timepoint.
Time frame: Day 1 (Visit 1), Day 29 (Visit 5), and Day 78 (Visit 12), up to 78 days
Single Serum LNG PK Measures at Various Times On-treatment and Post Treatment.
Serum LNG measures at Day 2 (Visit 2), Day 8 (Visit 4), Day 15 (Visit 6), Day 22 (Visit 8), Days 30, 36, 43, 50, 57, 64, 71 (Visits 11-17), Days 79, 80, 81, 82, 85 (Visits 19-23)
Time frame: Treatment Days 2, 8, 15, 22, 30, 36, 43, 50, 57, 64, 71, 79, 80, 81, 82, and 85, up to 85 days
Changes From Baseline in Estradiol Levels
Changes from Baseline (Visit 1) in Estradiol levels measured at Visits 3-10, Visit 12-18, Visit 23 (Days 0, 5, 8, 11, 15, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, 85)
Time frame: Days 0, 5, 8, 11, 15, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, 85, up to 85 days
Changes From Baseline in Luteinizing Hormone Levels
Changes from Baseline (Visit 1) in LH levels measured at Visits 3-10, Visit 12-18, Visit 23 (Days 0, 5, 8, 11, 15, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, 85)
Time frame: Days 0, 5, 8, 11, 15, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, 85, up to 85 days
Changes From Baseline in Follicle-Stimulating Hormone Levels
Changes from Baseline (Visit 1) in FSH levels measured at Visits 10/Day 29, Visit 15/Day 57, Visit 18/Day 78, Visit 23/Day 85
Time frame: Days 0, 29, 57, 78, 85, up to 85 days
Changes From Baseline in Sex Hormone-Binding Globulin Levels
Changes from Baseline (Visit 1) in SHBG levels measured at Visits 10/Day 29, Visit 15/Day 57, Visit 18/Day 78, Visit 23/Day 85
Time frame: Days 0, 29, 57, 78, 85, up to 85 days
Ovarian Follicular Activity Measured by the Number of Follicles Greater Than or Equal to 6mm
Number of follicles greater than or equal to 6mm at Baseline, Visits 1-10, Visits 12-18 (Days 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78)
Time frame: Days 0, 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, up to 78 days
Ovarian Follicular Activity Measured by the Maximum Diameter of the Largest Ovarian Follicle
Maximum diameter of largest ovarian follicle measured at Baseline, Visits 1-10, Visits 12-18 (Days 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78)
Time frame: Days 0, 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, up to 78 days
Ovarian Follicular Activity Measured by the Average Diameter of the Largest Ovarian Follicle
Average diameter of largest ovarian follicle measured at Baseline, Visits 1-10, Visits 12-18 (Days 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78)
Time frame: Days 0, 1, 5, 8, 11, 18, 22, 25, 29, 36, 43, 50, 57, 64, 71, 78, up to 78 days
Number of Subjects That Possibly Ovulated (Serum Progesterone 3-10 ng/mL)
Number of subjects that possibly ovulated based on serum progesterone \> 3.0 ng/mL but \<10 ng/mL measured during Weeks 1-4, 5-8, 9-11, and Post-Treatment Week 12
Time frame: Weeks 1-4, 5-8, 9-11, and Post-Treatment Week 12, up to 12 weeks
Number of Subjects That Likely Ovulated (Serum Progesterone > 10 ng/mL)
Number of subjects that possibly ovulated based on serum progesterone \> 10 ng/mL measured during Weeks 1-4, 5-8, 9-11, and Post-Treatment Week 12
Time frame: Weeks 1-4, 5-8, 9-11, and Post-Treatment Week 12, up to 12 weeks
Bleeding Patterns Based on Number of Bleeding/Spotting Days
Bleeding and spotting days are recorded via subject diary and the number of days of bleeding and spotting are assessed during Weeks 1-4, Weeks 5-8, Weeks 5-9, and Post-Treatment Week 12
Time frame: Weeks 1-4, Weeks 5-8, Weeks 5-9, and Post-Treatment Week 12, up to 12 Weeks
Patch Wearability Based on Skin Irritation
Patch wearability measured by patch site skin irritation at Visit 4, Visit 6, Visit 8, Visit 10, Visits 12-18 (Days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78) based on the following criteria: None= No irritation or barely perceptible/spotty erythema; Mild= Mild erythema covering approximately \<50% of the application site; Moderate = Moderate erythema covering approximately \>=50% of the application site, possible presence of mild edema; Significant = Severe erythema, possible edema, vesiculation, bullae and/or ulceration.
Time frame: Days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, 78, up to 78 days
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