- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02431897
Investigation to Minimize Prolapse Recurrence of the Vagina Using Estrogen (IMPROVE)
August 23, 2023 updated by: David Rahn, MD, University of Texas Southwestern Medical Center
This study randomizes postmenopausal women with symptomatic pelvic organ prolapse planning native tissue transvaginal surgical repair to 6-8 weeks of preoperative and 1-year continued postoperative vaginal estrogen cream compared to placebo cream.
This clinical trial and basic science investigation are designed to understand the mechanisms by which local estrogen treatment affects connective tissues of the pelvic floor and determine whether its use before and after prolapse repair will (i) improve success rates of the surgical intervention and minimize prolapse recurrence and (ii) impact favorably upon symptoms of other pelvic floor disorders.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
This is a double-blind randomized trial of intravaginal estrogen (conjugated estrogens, 0.625mg/1g cream) vs. placebo in postmenopausal women (up to n=222 enrolled and randomized in order for 188 to undergo surgery) with symptomatic prolapse beyond the hymen planning transvaginal native tissue repairs.
Medication will be started >5 weeks before surgery and continued for 1 year postoperatively, i.e. until scar remodeling is complete.
The investigators aim to determine if pre- and postoperative intravaginal estrogen therapy (i) results in anatomic and patient-reported subjective improvement in pelvic organ support, and (ii) impacts other pelvic floor disorders (overactive bladder and incontinence, sexual function and pain, postoperative cystitis), satisfaction, quality of life, and vaginal wound healing.
Finally, (iii) the investigators will determine the potential mechanisms by which local estrogen treatment alters pelvic organ support by examining full-thickness vaginal wall biopsies taken at the time of surgery for histologic, connective tissue, and smooth muscle synthesis and degradative changes.
The investigators expect this will highlight other novel targets for future therapies in prolapse repair and prevention.
Study Type
Interventional
Enrollment (Actual)
206
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States, 35249
- University of Alabama at Birmingham
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02905
- Women & Infants Hospital of Rhode Island
-
-
Texas
-
Dallas, Texas, United States, 75390
- University of Texas Southwestern Medical Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
48 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Postmenopausal: no menses for >1 year
- Minimum age: 48 years
- Symptomatic apical and/or anterior vaginal wall prolapse, stage 2 or greater
- No estrogen replacement within the last month (may come off current treatment, i.e. wash out, to join the study)
- Medically fit for elective surgery
- Physically able to apply/insert the study drug
- Available for clinic follow-up for minimum 1yr
Exclusion Criteria:
- Concurrent use of steroid creams for other indications (e.g. lichen sclerosis)
- BMI >35 kg/m2
- Recent history (within last month) of vaginal infection or vaginitis
- Contraindications to estrogen therapy (e.g. spontaneous DVT, stroke, breast or endometrial/ hormone-responsive cancer, genital bleeding of unknown cause)
- History of connective tissue disease
- Any oral or transdermal estrogen, SERM, or other medication impacting vaginal milieu
- History of vaginal irradiation
- Allergy to Premarin or its constituents
- Prior apical repair or use of mesh for prolapse repair
- Current tobacco use
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo Cream
Placebo cream
|
1g applied vaginally nightly for 2 weeks then 2x/week for >5 weeks before surgery, then 2x/week for 1 year after surgery.
|
Experimental: Estrogen Cream
Conjugated Estrogens cream
|
0.625mg/1g cream, 1g applied vaginally nightly for 2 weeks then 2x/week for >5 weeks before surgery, then 2x/week for 1 year after surgery.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Surgical "Failure" Defined by (i) Anatomic Assessment of Prolapse, (ii) Presence of Bulge Symptoms, and/or (Iii) Retreatment of Prolapse
Time Frame: 12 months
|
Cumulative failures, as measured by (i) anatomic assessment of prolapse, (ii) presence of bulge symptoms, and/or (iii) retreatment of pelvic organ prolapse
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Condition Specific (i.e. Pelvic Organ Prolapse) Symptom Bother as Measured by Pelvic Floor Distress Inventory-20 (PFDI-20) Questionnaire
Time Frame: 12 months
|
Questionnaire score at 12 months in overall condition-specific symptom bother as measured by Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire, which is scored from 0-300, higher scores being worse (i.e., more distressing)
|
12 months
|
Condition Specific (i.e. Pelvic Organ Prolapse) Quality of Life as Measured by Pelvic Floor Impact Questionnaire-7 (PFIQ-7)
Time Frame: 12 months
|
Questionnaire score at 12 months in overall condition-specific quality of life as measured by Pelvic Floor Impact Questionnaire-7 (PFIQ-7) questionnaire, which is scored from 0-300, higher scores being worse (i.e., more distressing)
|
12 months
|
Generic Quality of Life as Measured by SF-12 Questionnaire
Time Frame: 12 months
|
Generic (physical component) quality of life as measured by SF-12 questionnaire at 12 months.
Scores range from 0-100, with higher scores indicating better physical functioning; the US population average is 50 points.
|
12 months
|
Urinary Symptoms as Measured by Urinary Subscale Questions of the Pelvic Floor Distress Inventory-20 (PFDI-20) Questionnaire, i.e. the Urinary Distress Inventory, UDI-6
Time Frame: Time of surgery
|
Urinary symptom bother as measured by urinary subscale questions of the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire, i.e. the Urinary Distress Inventory, UDI-6.
This is scored from 0-100, with greater scores indicating greater symptom bother.
|
Time of surgery
|
Urinary Symptoms as Measured by Urinary Subscale Questions of the Pelvic Floor Distress Inventory-20 (PFDI-20) Questionnaire, i.e. the Urinary Distress Inventory, UDI-6
Time Frame: 12 months
|
Urinary symptom bother as measured by urinary subscale questions of the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire, i.e. the Urinary Distress Inventory, UDI-6.
This is scored from 0-100, with greater scores indicating greater symptom bother.
|
12 months
|
Urinary Symptoms as Measured by Urinary Subscale Questions of the Pelvic Floor Impact Questionnaire (PFIQ-7), i.e. the Urinary Impact Questionnaire
Time Frame: Time of surgery
|
Urinary symptom impact on quality of life as measured by urinary subscale questions of the Pelvic Floor Impact Questionnaire (PFIQ-7), i.e. the Urinary Impact Questionnaire.
This is scored from 0-100, with greater scores indicating worse impact on quality of life.
|
Time of surgery
|
Urinary Symptoms as Measured by Urinary Subscale Questions of the Pelvic Floor Impact Questionnaire (PFIQ-7), i.e. the Urinary Impact Questionnaire
Time Frame: 12 months
|
Urinary symptom impact on quality of life as measured by urinary subscale questions of the Pelvic Floor Impact Questionnaire (PFIQ-7), i.e. the Urinary Impact Questionnaire.
This is scored from 0-100, with greater scores indicating worse impact on quality of life.
|
12 months
|
Sexual Function as Measured by the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)
Time Frame: Time of surgery
|
Sexual function in sexually-active women as measured by the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR).
The score ranges from 1 (worse sexual experience) to 5 (better sexual experience) with midrange scores commonly seen in women with pelvic floor disorders.
|
Time of surgery
|
Sexual Function as Measured by the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)
Time Frame: 12 months
|
Sexual function in sexually-active women as measured by the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR).
The score ranges from 1 (worse sexual experience) to 5 (better sexual experience) with midrange scores commonly seen in women with pelvic floor disorders.
|
12 months
|
Number of Participants With Adverse Events
Time Frame: 12 months
|
Number of participants reporting any adverse events from baseline randomization to 12 months postoperatively
|
12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: David D Rahn, MD, University of Texas Southwestern Medical Center
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
December 1, 2016
Primary Completion (Actual)
November 29, 2021
Study Completion (Actual)
May 17, 2023
Study Registration Dates
First Submitted
April 23, 2015
First Submitted That Met QC Criteria
April 27, 2015
First Posted (Estimated)
May 1, 2015
Study Record Updates
Last Update Posted (Estimated)
September 6, 2023
Last Update Submitted That Met QC Criteria
August 23, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Urologic Diseases
- Urinary Bladder Diseases
- Uterine Diseases
- Disease Attributes
- Pathological Conditions, Anatomical
- Pregnancy Complications
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Genital Diseases
- Genital Diseases, Female
- Recurrence
- Prolapse
- Pelvic Organ Prolapse
- Pelvic Floor Disorders
- Cystocele
- Uterine Prolapse
- Physiological Effects of Drugs
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Estrogens
- Estrogens, Conjugated (USP)
Other Study ID Numbers
- STU 022015-117
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Pelvic Organ Prolapse
-
Coloplast A/SCompletedPelvic Organ Prolapse (POP)United States
-
University of CalgaryAlberta Health services; Cook Group IncorporatedCompletedAnterior Pelvic Organ ProlapseCanada
-
University of British ColumbiaCompletedPelvic Organ Prolapse, Patient EducationCanada
-
Unity Health TorontoUnknownVoiding Dysfunction After Pelvic Organ Prolapse SurgeryCanada
-
University of MelbourneCompletedVaginal Hysterectomy | Pelvic Organ Prolapse Vaginal SurgeryAustralia
-
Nykøbing Falster County HospitalZealand University Hospital; University Hospital, Gentofte, Copenhagen; Copenhagen...UnknownBenign Hysterectomy | Postoperative Pelvic Organ Prolapse | Suspension
-
Mackay Medical CollegeRecruitingPelvic Organ Prolapse | Stage III and IV High Grade Pelvic Organ ProlapseTaiwan
-
Peking Union Medical College HospitalUnknown
-
Gaziosmanpasa Research and Education HospitalRecruitingPatients With Pelvic Organ Prolapse | Pectopexy | Lateral Suspension | Pop-q | Pisq-12Turkey
-
Charles University, Czech RepublicUnknownPelvic Organ Prolapse RecurrenceCzech Republic
Clinical Trials on Conjugated Estrogens Cream
-
University of Alabama at BirminghamCompletedVaginal Atrophy | Female Urogenital Diseases | Postmenopausal Symptoms | Postmenopausal Atrophic Vaginitis | Genitourinary DiseaseUnited States
-
Medstar Health Research InstitutePfizerTerminatedMicroscopic HematuriaUnited States
-
TriHealth Inc.CompletedPelvic Organ Prolapse | Vaginal AtrophyUnited States
-
Fayoum UniversityRecruitingAtrophic Vaginitis | Postmenopausal Atrophic VaginitisEgypt
-
Wyeth is now a wholly owned subsidiary of PfizerCompleted
-
Lawson Health Research InstituteUniversity of Western Ontario, Canada; Academic Medical Organization of Southwestern...CompletedQuality of Life | Urinary Tract Infection | Vaginal InfectionCanada
-
Emory UniversityTerminatedSexual Dysfunction, PhysiologicalUnited States
-
The Cleveland ClinicPfizerUnknown
-
University of Texas Southwestern Medical CenterAmerican Urogynecologic Society Foundation Astellas Research AwardCompletedPelvic Organ Prolapse | MenopauseUnited States
-
University of LouisvilleCompletedMenopause | Atrophic Vaginitis | Recurrent Urinary Tract InfectionsUnited States