- ICH GCP
- Registr klinických studií v USA
- Klinická studie NCT07698561
Linzagolix in Adenomyosis and Recurrent Implantation Failure (LINZA-RIF)
Efficacy of Linzagolix 200 mg for 3 to 6 Months Prior to Embryo Transfer in Patients With Adenomyosis and Recurrent Implantation Failure: A Prospective Case Series
Adenomyosis is associated with impaired endometrial receptivity and reduced implantation rates in assisted reproduction, even when using high-quality embryos. Linzagolix (Yselty, 200 mg) is an oral GnRH receptor antagonist approved for uterine fibroids with a favourable tolerability profile and rapid elimination half-life (18-20 hours) compared to GnRH agonists.
This prospective case series evaluates the efficacy of linzagolix 200 mg administered for 3 to 6 months prior to embryo transfer in patients with confirmed adenomyosis and recurrent implantation failure (RIF), defined as ≥2 failed transfers with high-quality blastocysts (≥BB Gardner in oocyte donation, or PGT-A confirmed euploid in autologous cycles).
The primary endpoint is the live birth rate (LBR) per embryo transfer. Secondary endpoints include clinical pregnancy rate, miscarriage rate, morphological response of adenomyosis (uterine volume and junctional zone [JZ] thickness assessed by standardised transvaginal ultrasound), and tolerability profile. The study also explores the optimal treatment duration (3 vs 6 months) as a sub-analysis based on morphological response at the month-3 visit.
The study is conducted at three centres of Vida Fertility Institute (Madrid, Alicante and San Sebastián, Spain). Sample size: n=35 patients. Study duration: 24 months.
Přehled studie
Postavení
Intervence / Léčba
Detailní popis
BACKGROUND:
Current standard of care for adenomyosis prior to embryo transfer in RIF patients consists of GnRH agonist therapy (triptorelin depot) for 1-3 months, with or without letrozole. This approach requires intramuscular administration, is associated with intense vasomotor symptoms, and has a prolonged pharmacological residual effect (4-6 weeks) that complicates cycle planning. No prospective study has evaluated linzagolix in this specific clinical scenario.
DESIGN:
Prospective before-after case series. Each patient serves as her own historical control (prior failed transfers under standard care vs outcome after linzagolix treatment). Treatment duration (3 or 6 months) is determined by morphological response at the month-3 ultrasound visit. Endometrial preparation is initiated 7 days after the last dose of linzagolix.
ULTRASOUND PROTOCOL:
Standardised transvaginal ultrasound measurements at each visit: uterine volume (L x AP x T x 0.523 cm3), junctional zone maximum (mm), junctional zone minimum (mm) and junctional zone difference (mm). All measurements performed in strict sagittal plane with ≥7 MHz transvaginal probe.
VASOMOTOR SYMPTOM MANAGEMENT:
Standardised non-estrogenic supplementation protocol (Cimicifuga racemosa 20 mg, Remifemin) if EVA score ≥4 for hot flushes or insomnia. Suspended simultaneously with the last dose of linzagolix.
REGULATORY FRAMEWORK:
Observational study with medicinal products (EOMF) under Spanish Royal Decree 957/2020. Use of linzagolix in this indication is off-label. Study approved by CEIm del Hospital Clinico San Carlos, Madrid.
Typ studie
Zápis (Odhadovaný)
Kontakty a umístění
Studijní kontakt
- Jméno: Elena De Santiago Romero, MD
- Telefonní číslo: +34 679211353
- E-mail: santiago.e@vidafertility.com
Studijní záloha kontaktů
- Jméno: Irene Hervas, PhD
- Telefonní číslo: +34 697766609
- E-mail: hervas.i@vidafertility.com
Studijní místa
-
-
Alicante
-
Alicante, Alicante, Španělsko, 03008
- Vida Fertility Alicante
-
Kontakt:
- Sergio Rogel, MD
- Telefonní číslo: +34 669657631
- E-mail: rogel.s@vidafertility.com
-
Kontakt:
- Alejandra García Villalba, MD
- Telefonní číslo: +34 605920083
- E-mail: garciavillalba.a@vidafertility.com
-
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Gipuzkoa
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San Sebastián, Gipuzkoa, Španělsko, 20018
- Vida Fertility Donostia
-
Kontakt:
- Estefanía Rodriguez, MD
- Telefonní číslo: +34 653733284
- E-mail: rodriguez.e@vidafertility.com
-
-
Madrid
-
Madrid, Madrid, Španělsko, 28043
- Vida Fertility Institute Madrid
-
Kontakt:
- Elena De Santiago Romero, MD
- Telefonní číslo: +34 679211353
- E-mail: santiago.e@vidafertility.com
-
Kontakt:
- Irene Hervas, PhD
- Telefonní číslo: +34 697766609
- E-mail: hervas.i@vidafertility.com
-
-
Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
Přijímá zdravé dobrovolníky
Metoda odběru vzorků
Studijní populace
Popis
Inclusion Criteria:
- Age 18 to 50 years
- Confirmed adenomyosis by transvaginal ultrasound or MRI
- Recurrent implantation failure defined as 2 or more failed embryo transfers with high-quality blastocysts: oocyte donation recipients (blastocyst grade BB or above, Gardner classification) OR autologous IVF cycles with PGT-A confirmed euploid blastocysts
- Normal uterine cavity with no submucosal distortion
- At least 1 suitable embryo available for transfer (blastocyst grade BB or above, or PGT-A euploid)
- Signed written informed consent including explicit acknowledgement of off-label use of linzagolix
Exclusion Criteria:
- Untreated hydrosalpinx
- Untreated stage III-IV endometriosis
- Major uterine anomaly (uterine septum, bicornuate uterus)
- Known contraindication to linzagolix including known hepatopathy
- Prior treatment with linzagolix
- GnRH analogue treatment within 6 months prior to enrolment
- BMI greater than 35 kg/m2
- Prior failed transfers exclusively with embryos below the quality threshold (below BB grade, non-euploid)
Studijní plán
Jak je studie koncipována?
Detaily designu
Kohorty a intervence
Skupina / kohorta |
Intervence / Léčba |
|---|---|
|
Linzagolix 200 mg - Adenomyosis and RIF
Patients with confirmed adenomyosis and recurrent implantation failure (2 or more failed embryo transfers with high-quality blastocysts: grade BB or above in oocyte donation cycles, or PGT-A confirmed euploid in autologous cycles) receiving linzagolix 200 mg orally once daily for 3 to 6 months prior to embryo transfer.
Treatment duration is determined by morphological response assessed at the month-3 transvaginal ultrasound visit.
Endometrial preparation is initiated 7 days after the last dose of linzagolix.
|
Linzagolix 200 mg orally once daily for a minimum of 3 months, extendable to 6 months based on morphological response (uterine volume and junctional zone assessment) at the month-3 transvaginal ultrasound visit.
Off-label use for adenomyosis prior to embryo transfer.
Ostatní jména:
|
Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Live Birth Rate (LBR) per embryo transfer
Časové okno: Up to 12 months after embryo transfer
|
Proportion of embryo transfers resulting in the birth of a live neonate at or beyond 24 weeks of gestation.
|
Up to 12 months after embryo transfer
|
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Clinical Pregnancy Rate
Časové okno: 6-7 weeks after embryo transfer
|
Proportion of embryo transfers resulting in the presence of an intrauterine gestational sac with fetal heartbeat on transvaginal ultrasound at 6-7 weeks of gestation.
|
6-7 weeks after embryo transfer
|
|
Miscarriage Rate
Časové okno: Up to 22 weeks of gestation
|
Proportion of clinical pregnancies ending in spontaneous pregnancy loss before 22 weeks of gestation.
|
Up to 22 weeks of gestation
|
|
Change in Uterine Volume
Časové okno: Baseline, month 3, month 6 (if applicable) and pre-transfer (approximately 3-7 months from baseline)
|
Change in uterine volume (cm3) measured by transvaginal ultrasound using the ellipsoid formula (L x AP x T x 0.523) from baseline to post-treatment.
|
Baseline, month 3, month 6 (if applicable) and pre-transfer (approximately 3-7 months from baseline)
|
|
Change in Junctional Zone Maximum Thickness
Časové okno: Baseline, month 3, month 6 (if applicable) and pre-transfer (approximately 3-7 months from baseline)
|
Change in junctional zone (JZ) maximum thickness (mm) measured by standardised transvaginal ultrasound in strict sagittal plane from baseline to post-treatment.
|
Baseline, month 3, month 6 (if applicable) and pre-transfer (approximately 3-7 months from baseline)
|
|
Incidence of Vasomotor Adverse Events
Časové okno: Monthly during treatment period (up to 6 months)
|
Proportion of patients reporting hot flushes, insomnia or other vasomotor symptoms, assessed using a visual analogue scale (EVA 0-10) at each visit.
|
Monthly during treatment period (up to 6 months)
|
Spolupracovníci a vyšetřovatelé
Sponzor
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Primární dokončení (Odhadovaný)
Dokončení studie (Odhadovaný)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
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