Efficacy and Safety of FE 999049 in Controlled Ovarian Stimulation in Japanese Women

A Randomised, Controlled, Assessor-blind, Parallel Groups, Multicentre Trial Assessing the Efficacy and Safety of FE 999049 in Controlled Ovarian Stimulation in Japanese Women Undergoing an Assisted Reproductive Technology Programme

To demonstrate non-inferiority of FE 999049 compared to FOLLISTIM with respect to number of oocytes retrieved in Japanese IVF/ICSI patients undergoing controlled ovarian stimulation.

Study Overview

• Status: Completed
• Conditions: Infertility
• Intervention / Treatment: Drug: Follitropin delta; Drug: Follitropin beta

• Study Type: Interventional
• Enrollment (Actual): 373
• Phase: Phase 3

Contacts and Locations

Study Locations

• Japan
  • Akita, Japan
    • Akita University Hospital
  • Hyogo, Japan
    • Yamashita Ladies' Clinic
  • Saitama, Japan
    • Investigational Site 8126
  • Saitama, Japan
    • Omiya Ladies Clinic
  • Saitama, Japan
    • Saint Women's Clinic
  • Saitama, Japan
    • Women's Clinic Fujimino
  • Tokushima, Japan
    • Tokushima University Hospital
  • Aichi
    • Anjo, Aichi, Japan
      • Yachiyo Hospital
  • Chiba
    • Chiba-shi, Chiba, Japan
      • Investigational Site 8121
  • Gunma
    • Maebashi, Gunma, Japan
      • Yokota Maternity Hospital
  • Kanagawa
    • Sagamihara, Kanagawa, Japan
      • Sophia Ladies Clinic
  • Miyagi
    • Sendai-shi, Miyagi, Japan
      • Investigational Site 8122
  • Osaka
    • Higashiōsaka-shi, Osaka, Japan
      • Investigational Site 8123
    • Osaka-Shi, Osaka, Japan
      • Investigational Site 8120
    • Osaka-shi, Osaka, Japan
      • Ladies Clinic Kitahama
  • Saitama
    • Saitama-shi, Saitama, Japan
      • Investigational Site 8125
  • Tokyo
    • Shinjuku-Ku, Tokyo, Japan
      • Investigational Site 8124

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 38 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Informed Consent Documents signed prior to any trial-related procedures.
• In good physical and mental health.
• Japanese females between the ages of 20 and 40 years.
• Infertile women diagnosed with tubal infertility, unexplained infertility, endometriosis stage I/II (defined by the revised American Society for Reproductive Medicine (ASRM) classification) or with partners diagnosed with male factor infertility, eligible for in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatment using ejaculated sperm from male partner.
• Infertility for at least 1 year before randomization (not applicable in case of tubal or severe male factor infertility).
• The trial cycle will be the participant's first controlled ovarian stimulation cycle for IVF/ICSI.
• Hysterosalpingography, hysteroscopy, saline infusion sonography or transvaginal ultrasound documenting a uterus consistent with expected normal function (e.g. no evidence of clinically interfering uterine fibroids defined as submucous or intramural fibroids larger than 3 cm in diameter, no polyps and no congenital structural abnormalities which are associated with a reduced chance of pregnancy) within 1 year prior to screening. This also includes women who have been diagnosed with any of the above medical conditions but have had them surgically corrected within 1 year prior to screening.
• Transvaginal ultrasound documenting presence and adequate visualization of both ovaries, without evidence of significant abnormality (e.g. no endometrioma greater than 3 cm or enlarged ovaries which would contraindicate the use of gonadotropins) and fallopian tubes and surrounding tissue without evidence of significant abnormality (e.g. no hydrosalpinx) within 1 year prior to screening. Both ovaries must be accessible for oocyte retrieval.
• Early follicular phase (cycle day 2-4) serum levels of follicle stimulating hormone (FSH) between 1 and 15 IU/L (results obtained within 3 months prior to screening).
• Body mass index (BMI) between 17.5 and 32.0 kg/m^2 (both inclusive) at screening.

Exclusion Criteria:

• Known endometriosis stage III-IV (defined by the revised ASRM classification).
• One or more follicles >10 mm (including cysts) observed on the transvaginal ultrasound prior to start of stimulation on stimulation day 1 (puncture of cysts prior randomization is allowed).
• Known history of recurrent miscarriage (defined as three consecutive losses after ultrasound confirmation of pregnancy (excl. ectopic pregnancy) and before week 24 of pregnancy).
• Known abnormal karyotype of participant or of her partner. In case the sperm production is severely impaired (concentration <1 million/mL), normal karyotype, including no Y chromosome microdeletion, must be documented.
• Active arterial or venous thromboembolism or severe thrombophlebitis, or a history of these events.
• Any known clinically significant systemic disease (e.g. insulin-dependent diabetes).
• Any known endocrine or metabolic abnormalities (pituitary, adrenal, pancreas, liver or kidney) which can compromise participation in the trial with the exception of controlled thyroid function disease.
• Known tumours of the ovary, breast, uterus, adrenal gland, pituitary or hypothalamus which would contraindicate the use of gonadotropins.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Follitropin delta; FE 999049 was administered as single daily subcutaneous injections in the abdomen. Participants randomized to FE 999049 had their individual dose determined on the basis of their anti-Müllerian hormone (AMH) level at screening and their body weight at randomization. The daily FE 999049 dose was fixed throughout the stimulation period. The minimum allowed daily FE 999049 dose was 6 μg and maximum allowed daily dose was 12 μg. Dosing continued until the criterion for triggering of final follicular maturation was met. Participants could be treated for a maximum of 20 days.	Drug: Follitropin delta; Single daily subcutaneous administration through pre-filled injection pen; Other Names: FE 999049; REKOVELLE
Active Comparator: Follitropin beta; FOLLISTIM was administered as single daily subcutaneous injections in the abdomen. The starting dose of FOLLISTIM was 150 IU and fixed for the first five stimulation days, after which it could be adjusted by 75 IU based on the individual response. The maximum allowed daily dose was 375 IU. Dosing continued until the criterion for triggering of final follicular maturation was met. Participants could be treated for a maximum of 20 days.	Drug: Follitropin beta; Single daily subcutaneous injection in the abdomen; Other Names: FOLLISTIM

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Oocytes Retrieved	The number of oocytes retrieved was recorded at the oocyte retrieval visit.	36h (± 2h) after triggering of final follicular maturation (On day of oocyte retrieval)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Pregnancy Rate	Clinical pregnancy was defined as at least one gestational sac 5-6 weeks after transfer.	5-6 weeks after transfer (up to approximately 3 months after start of stimulation)
Positive Beta Unit of Human Chorionic Gonadotropin (Beta-hCG) Rate	Defined as positive serum beta-hCG test 13-15 days after transfer.	13-15 days after transfer (up to approximately 1.5 months after start of stimulation)
Vital Pregnancy Rate	Vital pregnancy was defined as at least one intrauterine gestational sac with fetal heart beat 5-6 weeks after transfer.	5-6 weeks after transfer (up to approximately 3 months after start of stimulation)
Implantation Rate	Implantation rate was defined as the number of gestational sacs 5-6 weeks after transfer divided by the number of blastocysts transferred.	5-6 weeks after transfer (up to approximately 3 months after start of stimulation)
Proportion of Participants With Cycle Cancellation Due to Poor or Excessive Ovarian Response		End-of-stimulation (up to 20 stimulation days)
Proportion of Participants With Blastocyst Transfer Cancellation Due to Excessive Ovarian Response / OHSS Risk		End-of-stimulation (up to 20 stimulation days)
Proportion of Participants With <4, 4-7, 8-14, 15-19 and ≥20 Oocytes Retrieved	Defined as proportion of participants grouped according to the number of oocytes retrieved. The proportion of participants with <4 oocytes (low response), 4-7 oocytes (moderate response), 8-14 oocytes (targeted response), 15-19 oocytes (hyperresponse) and ≥20 oocytes (severe hyperresponse) are presented.	On the day of oocyte retrieval (up to 22 days after start of stimulation)
Proportion of Participants With Extreme Ovarian Responses (Defined as <4, ≥15 or ≥20 Oocytes Retrieved) in Risk Population		On the day of oocyte retrieval (up to 22 days after start of stimulation)
Proportion of Participants With Preventive Interventions for Early Ovarian Hyperstimulation Syndrome (OHSS)		≤9 days after triggering of final follicular maturation
Proportions of Participants With Early OHSS (Including OHSS of Moderate/Severe Grade) and/or Preventive Interventions for Early OHSS	Defined as proportion of participants with early OHSS, early OHSS of moderate or severe grade, preventive interventions for early OHSS, early OHSS and/or preventive interventions for early OHSS, and early OHSS of moderate or severe grade and/or preventive interventions for early OHSS are presented.	Up to 9 days after triggering of final follicular maturation
Proportions of Participants With Late OHSS (Including OHSS of Moderate/Severe Grade)	Defined as proportions of participants with late OHSS (including OHSS of moderate/severe grade). Late OHSS was defined as OHSS with onset >9 days after triggering of final follicular maturation. The proportion of participants with late OHSS, and late OHSS of moderate or severe grade are presented. All OHSS cases were graded as mild, moderate, or severe.	>9 days after triggering of final follicular maturation
Number of Follicles on Stimulation Day 6	Defined as the number of follicles observed in both ovaries at the last transvaginal ultrasound (TVUS) in the stimulation phase (on stimulation Day 6).	At Day 6 of stimulation
Number of Follicles at End-of-stimulation	Defined as the number of follicles observed in both ovaries at the last TVUS in the stimulation phase (end-of-stimulation).	End-of-stimulation (up to 20 stimulation days)
Size of Follicles on Stimulation Day 6	Defined as size characteristics of follicles on stimulation Day 6. Average size of 3 largest follicles has been presented in this endpoint.	At Day 6 of stimulation
Size of Follicles at End-of-Stimulation	Defined as size characteristics of follicles at end-of-stimulation. Average size of 3 largest follicles has been presented in this endpoint.	End-of-stimulation (up to 20 stimulation days)
Fertilization Rate	The fertilization rate was defined as the number of oocytes with 2 pronuclei divided by the number of oocytes retrieved.	Day 1 after oocyte retrieval (up to approximately 22 days after start of stimulation)
Number and Quality of Embryos	Number of embryos (total and good-quality) on Day 3 are presented. A good-quality embryo was defined as an embryo with ≥6 blastomeres and fragmentation ≤20% on Day 3.	Day 3 after oocyte retrieval (up to approximately 24 days after start of stimulation)
Number and Quality of Blastocysts	Number of embryos (total and good-quality) on Day 5 are presented. The quality evaluation of blastocysts consisted of assessment of three parameters, as per the Gardner & Schoolcraft system: blastocyst expansion and hatching status (graded: 1-6), inner cell mass (graded: A-D) and trophectoderm (graded: A-D). A good-quality blastocyst was defined as a blastocyst of grade 3BB or higher.	Day 5 after oocyte retrieval (up to approximately 26 days after start of stimulation)
Circulating Levels of Endocrine Parameters (Follicle-stimulating Hormone [FSH], Luteinising Hormone [LH]) on Stimulation Day 6	The median and inter-quartile range (IQR) of FSH and LH levels on stimulation Day 6 are presented.	At Day 6 of stimulation
Circulating Levels of Endocrine Parameters (Follicle-stimulating Hormone [FSH], Luteinising Hormone [LH]) at End-of-stimulation	The median and IQR of FSH and LH levels at end-of-stimulation are presented.	End-of-stimulation (up to 20 stimulation days)
Circulating Levels of Endocrine Parameter (Estradiol) on Stimulation Day 6	The median and IQR of estradiol levels on stimulation Day 6 are presented.	At Day 6 of stimulation
Circulating Levels of Endocrine Parameter (Estradiol) at End-of-stimulation	The median and IQR of estradiol levels at end-of-stimulation are presented.	End-of-stimulation (up to 20 stimulation days)
Circulating Levels of Endocrine Parameter (Progesterone) on Stimulation Day 6	The median and IQR of progesterone levels on stimulation Day 6 are presented.	At Day 6 of stimulation
Circulating Levels of Endocrine Parameter (Progesterone) at End-of-stimulation	The median and IQR of progesterone levels at end-of-stimulation are presented.	End-of-stimulation (up to 20 stimulation days)
Circulating Levels of Endocrine Parameters (Inhibin A) on Stimulation Day 6	The median and IQR of Inhibin A levels on stimulation Day 6 are presented.	At Day 6 of stimulation
Circulating Levels of Endocrine Parameters (Inhibin A) at End-of-stimulation	The median and IQR of Inhibin A levels at end-of-stimulation are presented.	End-of-stimulation (up to 20 stimulation days)
Circulating Levels of Endocrine Parameters (Inhibin B) on Stimulation Day 6	The median and IQR of inhibin B levels on stimulation Day 6 are presented.	At Day 6 of stimulation
Circulating Levels of Endocrine Parameters (Inhibin B) at End-of-stimulation	The median and IQR of inhibin B levels at end-of-stimulation are presented.	End-of-stimulation (up to 20 stimulation days)
Number of Stimulation Days		End-of-stimulation (up to 20 stimulation days)
Total Gonadotropin Dose of FE 999049		End-of-stimulation (up to 20 stimulation days)
Total Gonadotropin Dose of FOLLISTIM		End-of-stimulation (up to 20 stimulation days)
Number of Participants With Adverse Events (AEs) Stratified by Intensity	The frequency of participants with total AEs and AEs by categories of intensity (mild, moderate, severe) are presented. An AE was any untoward medical occurrence in a participants participating in clinical trial. The intensity of AE was classified using the following 3-point scale: mild = awareness of signs or symptoms, but no disruption of usual activity); moderate = event sufficient to affect usual activity (disturbing); or severe = inability to work or perform usual activities (unacceptable).	From signed informed consent up to 5-6 weeks after transfer
Proportion of Participants Who Had Markedly Abnormal Value Changes From Baseline in Clinical Chemistry Parameters at End-of-stimulation	Defined as number of participants with at least one markedly abnormal finding in clinical chemistry parameters (as assessed by investigator) were reported. The clinical chemistry parameters included: alanine transaminase (ALT), albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), bicarbonate, bilirubin direct, bilirubin total, blood urea nitrogen, calcium, chloride, cholesterol total, creatinine, gamma-glutamyl transpeptidase, glucose, lactate dehydrogenase, phosphorus, potassium, sodium, total protein, uric acid.	End-of-stimulation (up to 20 stimulation days)
Proportion of Participants Who Had Markedly Abnormal Value Changes From Baseline in Hematology Parameters at End-of-stimulation	Defined as number of participants with at least one markedly abnormal changes in hematology parameters (as assessed by investigator) were reported. Hematology parameters included: red blood cells, white blood cells, red blood cells morphology, white blood cells morphology, haemoglobin, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, platelets.	End-of-stimulation (up to 20 stimulation days)
Proportion of Participants Who Had Markedly Abnormal Value Changes From Baseline in Clinical Chemistry Parameters at End-of-trial	Defined as number of participants with at least one markedly abnormal finding in clinical chemistry parameters (as assessed by investigator) were reported. The clinical chemistry parameters included: alanine transaminase (ALT), albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), bicarbonate, bilirubin direct, bilirubin total, blood urea nitrogen, calcium, chloride, cholesterol total, creatinine, gamma-glutamyl transpeptidase, glucose, lactate dehydrogenase, phosphorus, potassium, sodium, total protein, uric acid.	Up to 5-6 weeks after transfer
Proportion of Participants Who Had Markedly Abnormal Value Changes From Baseline in Hematology Parameters at End-of-trial	Defined as number of participants with at least one markedly abnormal changes in hematology parameters (as assessed by investigator) were reported. Hematology parameters included: red blood cells, white blood cells, red blood cells morphology, white blood cells morphology, haemoglobin, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, platelets.	Up to 5-6 weeks after transfer
Frequency and Intensity of Injection Site Reactions	The presence of of injection site reactions (redness, itching, pain, swelling and bruising) immediately, 30 minutes and 24 hours after the injection are presented. The injection site reactions were assessed as none, mild, moderate and severe. The number of injection site reactions (mild, moderate or severe) based on all assessments performed is presented.	End-of-stimulation (up to 20 stimulation days)
Technical Malfunctions of the Administration Pens		End-of-stimulation (up to 20 stimulation days)

Collaborators and Investigators

• Sponsor: Ferring Pharmaceuticals
• Investigators: Study Director: Global Clinical Compliance, Ferring Pharmaceuticals

Publications and helpful links

General Publications

• Ishihara O, Arce JC; Japanese Follitropin Delta Phase 3 Trial (STORK) Group. Individualized follitropin delta dosing reduces OHSS risk in Japanese IVF/ICSI patients: a randomized controlled trial. Reprod Biomed Online. 2021 May;42(5):909-918. doi: 10.1016/j.rbmo.2021.01.023. Epub 2021 Feb 9.
• Ishihara O, Nelson SM, Arce JC. Comparison of ovarian response to follitropin delta in Japanese and White IVF/ICSI patients. Reprod Biomed Online. 2022 Jan;44(1):177-184. doi: 10.1016/j.rbmo.2021.09.014. Epub 2021 Sep 23.
• Fernandez-Sanchez M, Fatemi H, Garcia-Velasco JA, Heiser PW, Daftary GS, Mannaerts B. Incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders after gonadotropin-releasing hormone (GnRH) agonist trigger in "freeze-all" approach. Gynecol Endocrinol. 2023 Dec;39(1):2205952. doi: 10.1080/09513590.2023.2205952.

Study record dates

Study Major Dates

• Study Start (Actual): July 29, 2017
• Primary Completion (Actual): June 10, 2019
• Study Completion (Actual): July 8, 2019

Study Registration Dates

• First Submitted: July 13, 2017
• First Submitted That Met QC Criteria: July 21, 2017
• First Posted (Actual): July 25, 2017

Study Record Updates

• Last Update Posted (Actual): August 24, 2023
• Last Update Submitted That Met QC Criteria: August 9, 2023
• Last Verified: April 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Infertility; Physiological Effects of Drugs; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Follicle Stimulating Hormone
• Other Study ID Numbers: 000273

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No