- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04075149
Does Treatment of Androgen Excess Using Spironolactone Improve Ovulatory Rates in Girls With Androgen Excess? (CBS009)
October 25, 2023 updated by: Christine Burt Solorzano, University of Virginia
Adolescent girls with androgen excess have a higher rate of irregular periods and decreased ovulation rates compared to normal girls, and are considered at-risk for developing polycystic ovary syndrome (PCOS).
This pilot study will look at whether giving spironolactone might improve ovulation rates in girls with androgen excess, ages 13-19.
If this is true, spironolactone treatment to young girls might prevent PCOS from developing and avoid future infertility.
Study Overview
Status
Recruiting
Intervention / Treatment
Detailed Description
This is a non-randomized, clinical pilot study testing whether 16 weeks of spironolactone improves ovulation rates in post-menarcheal girls with androgen excess.
The investigators will recruit girls ages 13-19 with clinical or biochemical androgen excess (defined as hirsutism and/or elevated Tanner stage-specific free testosterone concentrations) who are 4 to 6 years post-menarche.
Girls will keep a menstrual diary and collect twice weekly saliva samples for progesterone and estradiol for 16 weeks before and for 16 weeks during spironolactone (if ≤ 60 kg, 50 mg twice daily; if > 60 kg, 100 mg twice daily [1.7-3.3 mg/kg/24 hr]) use.
Girls will be asked to continue to collect saliva twice weekly for progesterone and estradiol testing for an additional 16 weeks after discontinuation of spironolactone and to continue menstrual diaries off of study medication for 12 additional months to assess persistence of any spironolactone effect.
Ovulation events will be counted per 100 days based on definitive rises in salivary progesterone.
The primary outcome will be changes in ovulation rate during spironolactone use compared to baseline.
Changes in menstrual regularity via inter-menstrual interval will also be assessed as a secondary outcome of spironolactone administration.
Another secondary outcome will be changes in acne and/or hirsutism.
Study Type
Interventional
Enrollment (Estimated)
24
Phase
- Early Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Melissa Gilrain, BS
- Phone Number: 434-243-6911
- Email: pcos@virginia.edu
Study Contact Backup
- Name: Christine Burt Solorzano, MD
- Phone Number: 434-243-6911
- Email: pcos@virginia.edu
Study Locations
-
-
Virginia
-
Charlottesville, Virginia, United States, 22908
- Recruiting
- University of Virginia Center for Research in Reproduction
-
Contact:
- Melissa Gilrain
- Phone Number: 434-243-6911
- Email: pcos@virginia.edu
-
Principal Investigator:
- Christine Burt Solorzano, MD
-
-
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
13 years to 19 years (Child, Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Girls age 13 - 19 years, with clinical or biochemical HA (defined as hirsutism and/or elevated Tanner stage-specific free testosterone concentrations) that are 4-6 years post-menarche
- Screening labs within age-appropriate normal range
- Volunteers who are 18-19 y old must be willing and able to provide written informed consent.
- When the subject is a minor (i.e., age < 18 y), the subject and custodial parents must be willing and able to provide written informed assent and consent, respectively.
- Willingness to strictly avoid pregnancy (using non-hormonal methods) during the time of study.
Exclusion Criteria:
- Age < 13 or > 19 y
- Girls ≤ 3 years and ≥ 7 years post-menarche will be excluded
- Being a study of androgen excess in adolescent girls with HA, men and boys are excluded
- Inability to comprehend what will be done during the study or why it will be done
- Precocious puberty (breast development before age 7)
- Primary amenorrhea (no menses by age 16)
- BMI-for-age < 5th percentile
- Patients currently enrolled in another research protocol will be excluded, except for those enrolled in IRB-HSR 17633 DENND1A
- Obesity due to genetic syndrome (e.g. Prader-Willi syndrome)
- Cushing syndrome
- Positive pregnancy test or lactation. Subjects with a positive pregnancy test will be informed of the result by the screening physician. Under Virginia law, parental notification is not required for minors. However, the screening physician will encourage them to tell their parent(s) and counsel them about the importance of appropriate prenatal care and counseling. We will arrange follow-up for them at the Teen Health Clinic at the University of Virginia or their primary care physician's office in a timely manner.
- Diabetes mellitus
- History of congenital adrenal hyperplasia or 17-hydroxyprogesterone > 300 ng/dL in the follicular phase, which suggests the possibility of congenital adrenal hyperplasia. NOTE: If a 17-hydroxyprogesterone > 300 ng/dL is confirmed on repeat testing, and ACTH-stimulated 17-hydroxyprogesterone < 1000 ng/dL will be required for study participation.
- Total testosterone > 150 ng/dL
- Abnormal thyroid stimulating hormone (TSH) for age. Subjects with adequately treated hypothyroidism, reflected by normal TSH values, will not be excluded.
- Abnormal sodium, potassium, or bicarbonate concentrations, or elevated creatine concentration (confirmed on repeat)
- Subjects must not take exogenous steroids or any medications known to affect the reproductive axis or glucose metabolism for 3 months prior to the study (or in the 2 months prior to screening). Such medications include oral contraceptives, progestins, metformin, glucocorticoids, and antipsychotic medications
- If sexually active, subjects will be required to abstain and/or use barrier forms of contraception during the study.
Note: Abnormal laboratory studies may be confirmed by repeat testing to exclude laboratory error.
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: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Spironolactone
16 weeks without medication, then 16 weeks with medication, then 12 months without medication; spironolactone 50 mg tablets: 50-100 mg orally twice daily (1.7-3.3 mg/kg/24 hr)
|
Spironolactone is an androgen-receptor commonly used (off-label) for hyperandrogenism in girls and women.
It is used in this study to determine if androgen blockade can improve ovulation rates in girls with androgen excess, who often have low rates of ovulation in the years following menarche.
The spironolactone dose will be as follows: If ≤ 60 kg, 50 mg twice daily; if > 60 kg, 100 mg twice daily.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ovulation Rate Changes
Time Frame: Rates of ovulation during weeks 17-32 (on medication) and weeks 33-48 (after medication) compared to weeks 1-16 (baseline, prior to medication)
|
Ovulation rate during and after spironolactone compared to before medication.
Ovulation will be counted based on salivary progesterone levels.
The rate of ovulation will be defined as the number of ovulatory cycles per 100 days of follow-up.
|
Rates of ovulation during weeks 17-32 (on medication) and weeks 33-48 (after medication) compared to weeks 1-16 (baseline, prior to medication)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Menstrual Regularity Changes
Time Frame: IMI for weeks 1-16 (before medication, baseline), weeks 17-32 (on medication), and weeks 33-52 (after medication)
|
Menstrual length during and after spironolactone compared to before medication.
Changes in menstrual regularity will be assessed using inter-menstrual interval (IMI)
|
IMI for weeks 1-16 (before medication, baseline), weeks 17-32 (on medication), and weeks 33-52 (after medication)
|
Acne
Time Frame: weeks 16 and 32
|
Changes in acne before vs. after spironolactone treatment assessed using the Global Acne Grading System
|
weeks 16 and 32
|
Hirsutism
Time Frame: weeks 16 and 32
|
Changes in hirsutism before vs. after spironolactone assessed using a modified Ferriman-Gallwey scoring system
|
weeks 16 and 32
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Christine Burt Solorzano, MD, University of Virginia
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 18, 2019
Primary Completion (Estimated)
September 1, 2024
Study Completion (Estimated)
September 1, 2024
Study Registration Dates
First Submitted
August 29, 2019
First Submitted That Met QC Criteria
August 29, 2019
First Posted (Actual)
August 30, 2019
Study Record Updates
Last Update Posted (Actual)
October 27, 2023
Last Update Submitted That Met QC Criteria
October 25, 2023
Last Verified
October 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms
- Endocrine System Diseases
- Ovarian Cysts
- Cysts
- Ovarian Diseases
- Adnexal Diseases
- Gonadal Disorders
- 46, XX Disorders of Sex Development
- Disorders of Sex Development
- Urogenital Abnormalities
- Adrenogenital Syndrome
- Congenital Abnormalities
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Genital Diseases
- Genital Diseases, Female
- Polycystic Ovary Syndrome
- Hyperandrogenism
- Physiological Effects of Drugs
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Natriuretic Agents
- Diuretics
- Hormone Antagonists
- Mineralocorticoid Receptor Antagonists
- Diuretics, Potassium Sparing
- Spironolactone
Other Study ID Numbers
- 21768
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
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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