A single-center, randomized, open-label, parallel-group, multi-arm, phase II clinical trial in healthy women aged 18 to 35 years who have a documented ovulatory cycle prior to randomization.
MR-130A-01 is a progestin-only TDS containing NGMN as its progestin. NGMN is currently available in combination with EE in CHC TDSs Xulane® (US) and Evra® (EU), at doses of 150 mcg/day (Xulane® USPI 2022) and 203 mcg/day (Evra®SmPC 2022) respectively. In the currently planned dose-finding clinical trial the ovulation inhibition and the impact on further physiological functions and hormones of the three dose strengths of MR-130A-01 will be investigated in healthy pre-menopausal obese and non-obese women with ovulatory menstrual cycles. Eligible subjects will be randomized according to their body mass index (BMI) into one of 7 treatment arms with different doses and regimens of IMP administration. The IMPs which are transdermal patches, will be applied to the skin (upper outer arm, abdomen, buttock or back) and will be changed weekly. Depending on the treatment arm, either 4 or 3 patches of an allocated patch strength will be applied per cycle (28/0-day regimen and 21/7-day regimen). Patch adhesion will be assessed by the subjects daily and the results (adhesion scores) will be recorded in a diary. Throughout the clinical trial, ovarian activity will be monitored by TVUS, and blood samples will be collected for determination of progesterone (P), estradiol (E2), LH and FSH concentrations. The inhibition of ovulation will be assessed by Hoogland and Skouby Score (HSS). In addition, bleeding pattern will be assessed based on the subject's records of bleeding and its intensity in a diary.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
168
MR-130A-01 transdermal patch, containing 2.43 mg Norelgestromin, will be worn 28 days per cycle with no patch free period.
MR-130A-01 transdermal patch, containing 3.64 mg Norelgestromin, will be worn 28 days per cycle with no patch free period.
MR-130A-01 transdermal patch containing 4.86 mg Norelgestromin, will be worn 28 days per cycle with no patch free period
dinox GmbH
Berlin, Germany
Proportion of responder overall (subjects with no ovulation in both treatment cycles)
A responder is a subject with no ovulation. A responder is a subject with no ovulation. Ovulation during treatment is defined as a Hoogland-Skouby score 5 or 6 in combination with fulfilment of Landgren criterion.
Time frame: 56 days
Proportion of responder in cycle (subjects with no ovulation in one of the treatment cycles)
A responder is a subject with no ovulation. A responder is a subject with no ovulation. Ovulation during treatment is defined as a Hoogland-Skouby score 5 or 6 in combination with fulfilment of Landgren criterion.
Time frame: 56 days
For assessment of ovarian activity, Hoogland and Skouby score frequency analysis will be provided for:
* Subjects with either HSS 5 or 6 * Subjects with HSS \<5 * Subjects for each HSS from 1 to 6 * Subjects with HSS 5 or 6 and positive Landgren criterion * Subjects with HSS 5 or 6 and negative Landgren criterion. Frequency analysis will be provided per treatment arm for each of the treatment cycles.
Time frame: 56 days
Corpus luteum function will be evaluated in subjects by using Landgren criteria in conjunction with Hoogland and Skouby score. Frequency analysis will be provided for:
* Subjects with HSS 5 or 6 and positive Landgren criterion * Subjects with HSS 5 or 6 and negative Landgren criterion. Frequency analysis will be provided per treatment arm for each of the treatment cycles. Furthermore, frequency of occurrence of any Landgren criterion over both cycles will be calculated.
Time frame: 56 days
The diameter of the largest FLS in both the right and left ovary will be measured (for each, the mean diameter from two directions). The largest of all follicles is considered the dominant FLS (FLSdom) for that study day.
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MR-130A-01 Transdermal patch MR-130A-01 transdermal patch containing 4.86 mg Norelgestromin, will be worn 21 days with a 7-day patch free period.
From this, the subject-wise maximum FLS diameter (MFD) will be calculated separately for each treatment cycle and over both cycles. The maximum endometrial thickness (ETmax) subject-wise will be calculated for each treatment cycle and for the entire treatment period using transvaginal ultrasound. This will be reported per visit and for each of the treatment cycles
Time frame: 56 days
The effect of cervical mucus will be calculated by Insler score. The subject-wise maximum Insler score (ISmax) will be calculated for each treatment cycle and for the entire treatment period.
Time frame: 56 days
To assess the effects of MR-130A-01 on sexual hormones(estradiol [E2], progesterone [P]) hormone concentrations determined in serum
Descriptive statistics will be given per treatment arm for: Concentrations of FSH, LH, E2, and P at each visit • Max FSH, max LH, max E2, mean E2, max P in each treatment cycle and over both cycles
Time frame: 56 days
Steady state concentration of NGMN and norgestrel will be calculated per treatment arm by means of non-compartmental analysis.
Descriptive statistics (N, arithmetic means, SD, medians, minimum, maximum geometric means, geometric CV) will be presented for all pharmacokinetic parameters, separately for each treatment and analyte.
Time frame: 56 days
Patch adhesion will be evaluated by both data subject diary and site personnel.
Frequency analysis of patch adhesion scores will be provided per treatment arm * For each day of the application period of one patch (Day 1 to Day 7) * For the subject-wise mean and maximum application score over the entire application period of one patch (1 week). In addition, the following evaluations will be presented per treatment arm for each evaluation time-point (day/week): * Proportion of subjects achieving greater than 90% adherence (score 0) * Proportion of subjects with a meaningful degree of detachment (patch detachment ≥25% (estimated score ≥2) * Number of patches that are completely detached (score 4).
Time frame: 56 days
Safety will be evaluated by TEAEs considering action taken, frequency, seriousness, intensity, relationship to the IMP, outcome as well as treatment.
Evaluation will be described by absolute and relative frequency. Tolerability will be evaluated by application site reactions. Frequency analysis of skin irritation categories will be provided per treatment arm over the entire treatment period.
Time frame: 56 days
Bleeding pattern will be assessed in each single subject over treatment cycle 1 and treatment cycle 2 (defined as 56-day reference period) by
* Incidences (percentage of subjects) of unscheduled/scheduled bleeding and/or spotting episodes within the reference period * The mean, median and range of number of observed days of bleeding and/or spotting within the reference period * The observed days of bleeding and/or spotting within the reference period presented as total days, unscheduled days and scheduled days for bleeding and/or spotting, bleeding only and spotting only * Incidences (percentage of subjects) of complete absence of bleeding or spotting during the reference period.
Time frame: 56 days