Phase 1b/2a Unblinded Study of Responses in Premenopausal Women With HSDD to Lorexys Evaluating Efficacy and Safety (PURPLE)

A Phase 1-b Non-blinded Study of Safety, Tolerability and Efficacy of Lorexys in Premenopausal Women With Hypoactive Sexual Desire Disorder

The purpose of this study is to investigate whether Lorexys is effective and safe to treat premenopausal women who have lost their sexual desire to a distressing degree.

Study Overview

• Status: Completed
• Conditions: Hypoactive Sexual Desire Disorder (DSM-IV-TR Defined); Sexual Interest/Arousal Disorder (DSM-5 Defined)
• Intervention / Treatment: Drug: bupropion, Lorexys low-dose, Lorexys moderate-dose

Detailed Description

Women are diagnosed with Hypoactive sexual desire disorder (HSDD) if they experience chronic loss of desire for sex together with significant distress or interpersonal difficulties due to this lack of desire. HSDD can have a serious effect on emotional well-being and interpersonal relationships.

There are no U.S. Food and Drug Administration-approved treatments for HSDD. Off-label treatments include testosterone, which is not always effective and can be accompanied by side effects such as excess hair growth, acne, and decreases in high-density lipoprotein (HDL) cholesterol levels.

Research in laboratory animals and clinical observations in humans suggest that re-balancing chemical messengers in the brain may stimulate sexual desire. S1 Biopharma's Lorexys® is a novel use fixed-dose combination (FDC) in an oral pill. Lorexys® combines two agents intended to restore balance to the brain's centers that control sexual function. Such effects are hoped to help women with HSDD.

The compound is Phase 2-ready without prior trials (Phase I safety studies) because the two agents have often been used together; individually, they are FDA-approved for treating other disorders (depression, for example), and in a large US survey, the two were taken together in about 23% of patients who were prescribed one of the two agents.

This research study requires subjects to take three different study medications for four weeks each, with at least a one-week "wash-out" period after each, and to report on rating scales how they feel. The medication is open-label (the subjects can see which medication they are receiving). That should not interfere with the evaluations or cause a big "placebo effect" because only a low proportion of women with HSDD have responded to a placebo in prior research studies of other compounds when using the same measures of efficacy.

Participation lasts 16 weeks, with 8 clinic visits. A weekly, but no daily, self-rating is required between visits.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Beachwood, Ohio, United States, 44122
      • Robert Taylor Segraves, MD, PhD
    • Cincinnati, Ohio, United States, 45219
      • Molly Katz, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 46 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Age 25 to 50 and still having regular menstrual periods. Women with intact ovaries are classified as premenopausal for this study, even if they have had a hysterectomy. Women who have had both ovaries removed, even if under age 50 and with an intact uterus, are not acceptable for this study.
2. In a stable, monogamous, communicative, reasonably amicable relationship for at least one year
3. Meets DSM-IV-TR criteria for Generalized Acquired Hypoactive Sexual Desire Disorder and HSDD is her main sexual disorder
4. Over the prior month, didn't respond to sexual initiations by partner
5. At screen and baseline, low or no and infrequent or rare desire for sex
6. At screen, has clinically relevant sexual distress as per FSDS-R score
7. Otherwise healthy physically and mentally. Minor chronic conditions not affecting sexual function are allowed. Side effects from any continuing concomitant medications must be mild and stable or nil.
8. Not pregnant or lactating for six months; using medically reliable contraception, i.e., diaphragm or (male or female) condom and spermicide, IUD, tubal sterilization, hormonal contraception (oral, vaginal, or implant), or (if the investigator finds the patient credibly monogamous) vasectomy of male partner.
9. Gives informed consent for and is willing to undergo all of the scheduled evaluations
10. Prompt for screening and baseline visits, is cooperative, and takes reasonable directions without excessive explanations
11. Her sexual partner is in a monogamous relationship with her, is sexually unimpaired (erectile dysfunction allowed only if adequately treated), and is available to her at least half of the time (in days per week).

Exclusion Criteria:

1. Masturbates more than once a month.
2. Sexual aversion or sexual pain disorder
3. Chronic conditions that may reasonably be expected to be unstable or to affect sexual function (e.g., gastrointestinal bleeding, diabetes, frequent asthma, Major Depressive or anxiety disorder, history within the prior 6 months of suicidality or drug abuse; history of breast, cervical, uterine, ovarian or other systemic cancer).
4. BMI (a standard ratio of weight to height) over 35.0 (obese)
5. Requires CYP3A4, CYP 2B6, or CYP 2D6 strong inhibitor or inducer drugs
6. Takes any sex hormone other than an approved hormonal contraceptive
7. Takes an antiepileptic/mood stabilizer, antipsychotic, antidepressant, anti-anxiety, or hypnotic drug or has a history of allergic reaction to such drugs

9. Drinks more than 7 alcoholic drinks per week (12-oz beer, 4-oz wine, 1 ½ oz liquor etc) 10. Drinks more than 6 cups of coffee or tea per day 11. History of seizures 12. Long QT syndrome (QTc <=480 msec), other significant cardiovascular disease 13. moderate or severe dysfunction of the liver (any LFT >=3x ULN) or renal dysfunction (BUN > 30 or Cr >2.0) 14. Uses sedating antihistamines or prescription sedatives 15. History of blood clots or abnormal bleeding tendencies, including daily use of medications adversely affecting coagulation, e.g., NSAIDs, systemic corticosteroids, or >81 mg aspirin daily.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bupropion -> Lorexys LO -> Lorexys HI; Crossover with all on positive comparator,lower-dose Lorexys,higher-dose Lorexys	Drug: bupropion, Lorexys low-dose, Lorexys moderate-dose; Lorexys is a proprietary fixed-dose combination of two agents; Other Names: Lorexys is bupropion plus trazodone; Lorexys lower-dose is 225 mg per day.; Lorexys moderate-dose is 450 mg per day.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Desire domain of the Female Sexual Function Index	One item asks how often the subject feels sexual desire, and another item asks how much she feels desire. One of five answers must be checked for each item.	Four weeks after baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Female Sexual Distress Scale-Revised	The subject self-rates 13 negative feelings, such as frustration, bother, and unhappiness, that may have occurred because of her sexual problems.	Four weeks after baseline
Change in Side Effects Checklist - 24 item	The subject self-rates how much (if any) she has been bothered by each of the 24 symptoms that have been commonly reported with similar drugs, such as headache, sleepy, and anxious, from "not at all" to "extremely."	4 weeks after baseline
Patient's Global Impression of Change	Subject self-rates how much, if any, her sexual disorder has changed since starting the current study medication (worse, same, or 4 degrees of improvement)	4 Weeks after baseline
Change in blood pressure and pulse	Blood pressure and pulse are taken lying and standing	Four weeks after baseline
Change in 12-lead electrocardiogram	An electrocardiogram is used to measure the regularity of the heartbeat and how well electrical impulses are transmitted through the heart	15 weeks (end of last treatment) after screen
Change in routine lab studies including pregnancy tests and screen for illicit drugs	About two teaspoons of blood are drawn to measure blood cells and body chemistry, and to see if the patient has become pregnant or has taken unauthorized substances.	Screen (wk 0), end of treatment/new baseline (wks 6, 11, 15)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Columbia Suicide Severity Rating Scale, Screen Version (6 items)	Brief interview of 3-6 specified questions asking if the patient feels like, wants to, or plans to be dead	4 weeks after baseline

Collaborators and Investigators

• Sponsor: S1 Biopharma, Inc.
• Investigators: Principal Investigator: Robert T Segraves, MD, PhD, Levine, Risen & Associates, Inc.; Principal Investigator: Molly Katz, MD, Katz and Kade, Inc.; Study Director: Robert E Pyke, MD, PhD, Chief Medical Officer, S1 Biopharma, Inc.

Publications and helpful links

General Publications

• Moll JL, Brown CS. The use of monoamine pharmacological agents in the treatment of sexual dysfunction: evidence in the literature. J Sex Med. 2011 Apr;8(4):956-70. doi: 10.1111/j.1743-6109.2010.02190.x. Epub 2011 Jan 27.

Study record dates

Study Major Dates

• Study Start: April 1, 2013
• Primary Completion (Actual): October 1, 2014
• Study Completion (Actual): October 1, 2014

Study Registration Dates

• First Submitted: May 10, 2013
• First Submitted That Met QC Criteria: May 15, 2013
• First Posted (Estimate): May 20, 2013

Study Record Updates

• Last Update Posted (Estimate): October 28, 2014
• Last Update Submitted That Met QC Criteria: October 26, 2014
• Last Verified: October 1, 2014

More Information

Terms related to this study

• Keywords: Sexual Interest/Arousal Disorder; Female Sexual Dysfunction; Hypoactive Sexual Desire Disorder; Lorexys; Premenopausal female health
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Nervous System Diseases; Neurologic Manifestations; Dyskinesias; Disease; Hypokinesia; Sexual Dysfunctions, Psychological; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Enzyme Inhibitors; Tranquilizing Agents; Psychotropic Drugs; Serotonin Uptake Inhibitors; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Serotonin Agents; Antidepressive Agents; Dopamine Agents; Anti-Anxiety Agents; Cytochrome P-450 Enzyme Inhibitors; Antidepressive Agents, Second-Generation; Cytochrome P-450 CYP2D6 Inhibitors; Dopamine Uptake Inhibitors; Bupropion; Trazodone
• Other Study ID Numbers: S1P-104-1000