- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03568708
Primary Ovarian Insufficiency: Phenotype and Optimal Treatment
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: Primary ovarian insufficiency (POI) is an enigmatic condition that affects ~1/10,000 women by age 20. Sometimes referred to as "early menopause," POI is characterized by estrogen deficiency among other hormonal abnormalities that resemble the menopause. POI is a serious chronic condition with no cure. The clinical presentation or 'phenotype' in adolescents is not well understood. Health consequences may include delayed or arrested puberty, skeletal losses, and the threat to reproductive health. Both the metabolic and emotional sequelae are substantial, and one of the most concerning is compromised bone health. The optimal hormone replacement therapy (HRT) regimen for these young women is debated and practice varies among health providers. Importantly only sparse data exist to guide clinicians to make evidence-based decisions regarding the management of these patients. If initiated early, HRT may prevent estrogen-associated bone loss.
Impact: Better understanding of POI may lead to improved treatments for this underserved population and have significant implications for the treatment of estrogen deficiency in other populations of adolescents and young women, and for all women going though natural menopause later in life. Little is known about the effects of HRT on bone health, body composition, cognition, and health-related quality of life, especially among adolescents. Understanding how this therapy affects these multiple health outcomes will fill knowledge gaps regarding treatment for young patients with POI, with potential implications for adolescents and young women with estrogen deficiency in other clinical settings. We will define the clinical presentation (i.e., phenotype) of adolescent POI. The pilot data collected will be used in a future application to the National Institutes of Health, to fund a larger trial that builds on observations from this initial study. The information gained from this pediatric model may also provide insights on management of the natural menopause that occurs in all women later in life.
Methods: Ten adolescents with idiopathic POI (i.e., from unexplained causes) will be recruited through the CCHMC Teen Health Center, Endocrine or Pediatric/Adolescent Gynecology Clinics. Ten healthy controls will be recruited from the Teen Health Center. Participants with POI will receive transdermal estrogen replacement (beginning at 25 µg/patch applied weekly), with the dose increased at subsequent study visits that will occur at 3, 6, 12, 18, and 24 months. All data collection will take place at the CCHMC Schubert Research Clinic. The investigators will measure bone density of the central skeleton and body composition by dual-energy x-ray absorptiometry. To evaluate the peripheral skeleton, bone and muscle measures will be obtained by peripheral quantitative computed tomography. At each visit, the participants will have blood drawn to measure circulating hormone levels that are characteristically altered in adolescents with POI, along with safety assays. Cognitive functioning will be assessed using standardized tools. Participants will complete quality of life assessments, along with nutrition and physical activity surveys. Lastly, all participants will also complete a detailed medical history and health assessment.
Implications/Future Directions: Once the phenotype of adolescent POI is more clearly defined, a logical next question will be to determine whether negative health outcomes can be prevented or modified. Data from the proposed trial will guide the design of future prospective studies that evaluate the effects of traditional treatments (e.g., HRT), including a longer study to monitor HRT therapy, as well as more experimental treatments (e.g., skeletal agents) that may benefit young women with this rare condition. In addition, findings are expected to open avenues of research for adolescents and women with estrogen deficiency in other clinical settings.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
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Ohio
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Cincinnati, Ohio, United States, 45229
- Cincinnati Children's Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria for POI patients
The participant must:
- Be willing to give informed consent/assent
- Have a diagnosis of POI based on 2 elevated serum FSH levels obtained >1 month apart
- Be English-speaking
Exclusion Criteria for POI patients
The participant must not:
- Have other chronic disease known to affect bone health (e.g., cystic fibrosis, celiac disease, etc.)
- Have an identified secondary cause of ovarian insufficiency
- Have POI in the setting of Turner syndrome, Fanconi Anemia, galactosemia, or Perrault syndrome (as associated neurological/medical sequelae could confound baseline measures)
- Have used medications known to affect bone metabolism over previous 3 months (e.g. anticonvulsants, chronic use of glucocorticords, Depo-Provera, oral contraceptive pills)
- Be currently pregnant (to be confirmed by pregnancy testing)
Inclusion Criteria for Healthy Adolescent Control Participants
The participant must:
Be similar in age and race group to the idiopathic POI group
- Control participants age must be within one year of age from the POI participant at the time of enrollment. Age may be within one year older or one year younger
- Race of controls participants will be matched based on race of POI patient participants
- Have a BMI within 20% of the BMI of the case-matched participant
If postmenarchal, will be regularly menstruating (cycles between 21-35 days)
a. if POI participant is <12.5yrs (mean age of menarche) will match with a pre- menarchal control participant
- Be English-speaking
Exclusion Criteria for Healthy Adolescent Control Participants
The participant must not:
- Have a chronic disease, known to affect bone metabolism (e.g., cystic fibrosis, celiac disease, sickle cell disease, inflammatory bowel disease etc.)
- Be receiving medications known to affect bone metabolism over previous three months (e.g. anticonvulsants, chronic use of glucocorticoids, Depo-Provera, oral contraceptive pills, etc.)
- Have a learning disability or a developmental delay
- Be currently taking any SSRIs, antipsychotics or have any documented problems with anxiety or depression.
- Be currently pregnant (as confirmed by pregnancy testing)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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No Intervention: Control Participants
The control group will reflect a comparison group similar to the POI patient group.
As bone density, body composition, and cognitive domains continue to mature throughout the teenage years, this comparison group will provide an important metric of normal growth and development.
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Experimental: POI Participants
This group will be participants who have been recently diagnosed with POI.
In an open-label fashion, participants with POI will receive Transdermal Estrogen(beginning at a dose of 25 μg/patch applied weekly), with the dose increased at 3, 6 12, and 18 months (to 37.5, 50, 75, and 100 µg/patch).
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In an open-label fashion, participants with POI will receive transdermal estradiol (beginning at a dose of 25 µg/patch applied weekly), with the dose increased at 3, 6 12, and 18 months (to 37.5, 50, 75, and 100 µg/patch).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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DXA Measure of Bone Mineral Density
Time Frame: Change in bone mineral density and body composition from baseline to 24 months
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DXA measures of the lumbar spine
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Change in bone mineral density and body composition from baseline to 24 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Study Medications - patches
Time Frame: Adherence with intervention from baseline to 24 months
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Compliance with study medications as assessed by patch count at study visits
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Adherence with intervention from baseline to 24 months
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Study Medications - serum estradiol
Time Frame: Change in serum estradiol levels from baseline to 24 months
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Compliance with study medications as assessed by serum estradiol levels.
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Change in serum estradiol levels from baseline to 24 months
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pQCT
Time Frame: Change from baseline to 24 months
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To assess the appendicular (peripheral) skeleton, bone measures of the non-dominant radius will be obtained by pQCT
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Change from baseline to 24 months
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Bone age
Time Frame: Change from baseline to 24 months
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Radiograph of the left wrist to assess bone age for POI participants
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Change from baseline to 24 months
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Anthropometrics
Time Frame: Change from baseline to 24 months
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BMI in kg/m^2
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Change from baseline to 24 months
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Youth/Adolescent Questionnaire (YAQ)
Time Frame: Change from baseline to 24 months
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Nutrition survey
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Change from baseline to 24 months
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Child Health Questionnaire-Child Self-Report Form (CHQ-CF87)
Time Frame: Change from baseline to 24 months
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The tool consists of 12 summated subscales and is designed to measure the physical and psychosocial health of adolescents.
The subscales include change in health in the last year, bodily pain, behavior, mental health, among others.
Items are scored from 0-100, except for the change in health during the last year, and family cohesion variables, which are scored from 1-5.
Higher scores on all other variables indicate better quality of life.
This instrument has a record of reliability and validity for evaluating aspects of health that are pertinent across age, gender, health condition, and socioeconomic status in adolescents
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Change from baseline to 24 months
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Menopause Rating Scale (MRS)
Time Frame: Change from baseline to 24 months
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11-item self-report validated measure to assess symptoms associated with menopause.
The composite scores for each of the dimensions (sub-scales) is based on adding up the scores of the items of the respective dimensions.
The composite score (total score) is the sum of the dimension scores.
The three dimensions, their corresponding questions and the evaluation are detailed and summarized.
The total score of the MRS ranges between 0 (asymptomatic) and 44 (highest degree of complaints).
psychological symptoms: 0 to 16 scoring points ( 4 symptoms: depressed, irritable, anxious, exhausted) somato-vegetative symptoms: 0 to 16 points (4 symptoms: sweating/flush, cardiac complaints, sleeping disorders, joint & muscle complaints) urogenital symptoms: 0 to 12 points (3 symptoms: sexual problems, urinary complaints, vaginal dryness).
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Change from baseline to 24 months
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Child Depression Inventory-II (CDI-II)
Time Frame: Change from CDI-II score from baseline to 24 months
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A brief self-report test that helps assess cognitive, affective and behavioral signs of depression in children and adolescents 7 to 17 years old.
Scales include Emotional and Functional Problems, along with subscales of Negative mood/Physical symptoms, Negative Self-Esteem, Interpersonal Problems, and Ineffectiveness.
Higher scores indicate more depressive symptoms for total scoring and subscale scores.
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Change from CDI-II score from baseline to 24 months
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Screen for Child Anxiety Related Disorders (SCARED)
Time Frame: Change from SCARED score baseline to 24 months
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A 41 item self-report tool to assess for anxiety.
A total score of ≥ 25 may indicate the presence of an Anxiety Disorder.
Scores higher than 30 are more specific.A score of 7 for items 1, 6, 9, 12, 15, 18, 19, 22, 24, 27, 30, 34, 38 may indicate Panic Disorder or Significant Somatic Symptoms.A score of 9 for items 5, 7, 14, 21, 23, 28, 33, 35, 37 may indicate Generalized Anxiety Disorder.
A score of 5 for items 4, 8, 13, 16, 20, 25, 29, 31 may indicate Separation Anxiety SOC.
A score of 8 for items 3, 10, 26, 32, 39, 40, 41 may indicate Social Anxiety Disorder.
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Change from SCARED score baseline to 24 months
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Children and Adolescent Memory Profile (CHAMP)
Time Frame: Change from score from baseline to 24 months
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The ChAMP is a norm-referenced test of memory and learning that was designed for use with children, adolescents, and young adults ranging from 5 through 21 years.
This test is administered directly to the participant by a trained examiner.
The survey is a comprehensive screen that allows both memory screening and in-depth memory evaluation.
The ChAMP includes 4 Subtests (Lists, Objects, Instructions, Places), each with immediate and delayed evaluation modules.
Composite scores yielded from this measure include: verbal memory index, visual memory index, immediate memory index, delayed memory index, and total memory index.
The ChAMP takes approximately 35 minutes to administer.
A score of 3 for items 2, 11, 17, 36 may indicate Significant School Avoidance.
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Change from score from baseline to 24 months
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DXA Measure of Bone Mineral Density
Time Frame: Change from baseline bone mineral density to 24 months
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To assess the axial (central) skeleton, DXA measure of the whole body
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Change from baseline bone mineral density to 24 months
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DXA Measure of Body Composition
Time Frame: Change from baseline body composition to 24 months
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To assess the axial (central) skeleton, DXA measure of the whole body
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Change from baseline body composition to 24 months
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Catherine Gordon, MD,Msc, Boston Children's Hospital and Cincinnati Children's Hospital Medical Center
- Principal Investigator: Halley Wasserman, MD, MSc, Children's Hospital Medical Center, Cincinnati
Publications and helpful links
General Publications
- Gordon CM, Kanaoka T, Nelson LM. Update on primary ovarian insufficiency in adolescents. Curr Opin Pediatr. 2015 Aug;27(4):511-9. doi: 10.1097/MOP.0000000000000236.
- Nelson LM. Clinical practice. Primary ovarian insufficiency. N Engl J Med. 2009 Feb 5;360(6):606-14. doi: 10.1056/NEJMcp0808697.
- Committee opinion no. 605: primary ovarian insufficiency in adolescents and young women. Obstet Gynecol. 2014 Jul;124(1):193-197. doi: 10.1097/01.AOG.0000451757.51964.98.
- Sadeghi MR. New hopes for the treatment of primary ovarian insufficiency/premature ovarian failure. J Reprod Infertil. 2013 Jan;14(1):1-2. No abstract available.
- Gordon CM, Zemel BS, Wren TA, Leonard MB, Bachrach LK, Rauch F, Gilsanz V, Rosen CJ, Winer KK. The Determinants of Peak Bone Mass. J Pediatr. 2017 Jan;180:261-269. doi: 10.1016/j.jpeds.2016.09.056. Epub 2016 Nov 3. No abstract available.
- Bakhsh H, Dei M, Bucciantini S, Balzi D, Bruni V. Premature ovarian insufficiency in young girls: repercussions on uterine volume and bone mineral density. Gynecol Endocrinol. 2015 Jan;31(1):65-9. doi: 10.3109/09513590.2014.958987. Epub 2014 Sep 9.
- Popat VB, Calis KA, Vanderhoof VH, Cizza G, Reynolds JC, Sebring N, Troendle JF, Nelson LM. Bone mineral density in estrogen-deficient young women. J Clin Endocrinol Metab. 2009 Jul;94(7):2277-83. doi: 10.1210/jc.2008-1878. Epub 2009 Apr 28.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Endocrine System Diseases
- Ovarian Diseases
- Adnexal Diseases
- Gonadal Disorders
- Primary Ovarian Insufficiency
- Menopause, Premature
- Physiological Effects of Drugs
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Contraceptive Agents, Hormonal
- Contraceptive Agents
- Reproductive Control Agents
- Contraceptive Agents, Female
- Estradiol
- Estradiol 17 beta-cypionate
- Estradiol 3-benzoate
- Polyestradiol phosphate
- Estrogens
Other Study ID Numbers
- FP00000706
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
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