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    Summary
    EudraCT Number:2017-001632-19
    Sponsor's Protocol Code Number:MVT-601-3102
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2020-11-10
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2017-001632-19
    A.3Full title of the trial
    SPIRIT 2: An International Phase 3 Randomized, Double-Blind, Placebo-Controlled Efficacy and Safety Study to Evaluate Relugolix Administered with and without Low-Dose Estradiol and Norethindrone Acetate in Women with Endometriosis-Associated Pain
    SPIRIT 2: Studio internazionale di fase 3, randomizzato, in doppio cieco, controllato verso placebo, volto a valutare l'efficacia e la sicurezza di relugolix somministrato con e senza estradiolo e noretindrone acetato a basso dosaggio in donne con dolore da endometriosi
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the efficacy and safety of relugolix in women with endometriosis-associated pain
    Studio volto a valutare l'efficacia e la sicurezza di relugolix in donne con dolore da endometriosi
    A.3.2Name or abbreviated title of the trial where available
    SPIRIT 2
    SPIRIT 2
    A.4.1Sponsor's protocol code numberMVT-601-3102
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMYOVANT SCIENCES GMBH
    B.1.3.4CountrySwitzerland
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMyovant Sciences GmbH
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMyovant Sciences GmbH
    B.5.2Functional name of contact pointLeonid Katz, M.D.Medical Monitor
    B.5.3 Address:
    B.5.3.1Street Address2000 Sierra Point Parkway, 9th Floor
    B.5.3.2Town/ cityBrisbane
    B.5.3.3Post codeCA 94005
    B.5.3.4CountryUnited States
    B.5.4Telephone number000000
    B.5.5Fax number000000
    B.5.6E-mailleonid.katz@myovant.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namerelugolix
    D.3.2Product code [TAK-385, RVT-601, MVT-601]
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNrelugolix
    D.3.9.1CAS number 737789-87-6
    D.3.9.2Current sponsor codeMVT-601
    D.3.9.3Other descriptive nameTAK-385
    D.3.9.4EV Substance CodeSUB168257
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name ACTIVELLE
    D.2.1.1.2Name of the Marketing Authorisation holderNOVO NORDISK
    D.2.1.2Country which granted the Marketing AuthorisationDenmark
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameActivelle® (1 mg estradiol / 0.5 mg norethindrone acetate)
    D.3.2Product code [na]
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNORETHISTERONE ACETATE
    D.3.9.1CAS number 51-98-9
    D.3.9.2Current sponsor codeNA
    D.3.9.3Other descriptive nameNORETHISTERONE ACETATE
    D.3.9.4EV Substance CodeSUB03457MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNESTRADIOL HEMIHYDRATE
    D.3.9.1CAS number 50-28-2
    D.3.9.2Current sponsor codeNA
    D.3.9.3Other descriptive nameESTRADIOL HEMIHYDRATE
    D.3.9.4EV Substance CodeSUB11941MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboCapsule, hard
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Endometriosis
    Endometriosi
    E.1.1.1Medical condition in easily understood language
    Endometriosis
    Endometriosi
    E.1.1.2Therapeutic area Diseases [C] - Female diseases of the urinary and reproductive systems and pregancy complications [C13]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10014778
    E.1.2Term Endometriosis
    E.1.2System Organ Class 10038604 - Reproductive system and breast disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1.To determine the benefit of relugolix 40 mg once daily co-administered with 24 weeks of low-dose estradiol and norethindrone acetate compared with placebo on dysmenorrhea;
    2.To determine the benefit of relugolix 40 mg once daily co-administered with 24 weeks of low-dose estradiol and norethindrone acetate compared with placebo on non-menstrual pelvic pain (NMPP).
    1 Determinare il beneficio di relugolix 40 mg somministrato una volta al giorno in concomitanza con estradiolo e noretindrone acetato a basso dosaggio per 24 settimane rispetto al placebo per la dismenorrea;
    2 Determinare il beneficio di relugolix 40 mg somministrato una volta al giorno in concomitanza con estradiolo e noretindrone acetato a basso dosaggio per 24 settimane rispetto al placebo per il dolore pelvico non mestruale (NMPP);
    E.2.2Secondary objectives of the trial
    To determine the benefit of relugolix 40 mg once daily co-administered with 24 weeks of low-dose estradiol and norethindrone acetate compared with placebo on the following:
    o Function measured by the EHP-30 Pain Domain,
    o Dysmenorrhea measured by the NRS; o PGIC for dysmenorrhea;
    o NMPP measured by the NRS;
    o PGIC for NMPP;
    o Dyspareunia measured by the NRS;
    o PGIC for dyspareunia;
    o Dyspareunia-related functional effects (sB&B);
    o Patient Global Assessment (PGA) for pain;
    o PGA for function;
    o Endometriosis-associated quality of life (Control and Powerlessness,Social Support, Emotional Well-Being, and Self-Image domains of the EHP-30);
    o Dysmenorrhea-related functional effects (sB&B);
    o NMPP-related functional effects (sB&B).
    o PGA for dysmenorrhea;
    o PGA for NMPP
    Determinare il beneficio di relugolix 40 mg somministrato una volta al giorno in concomitanza con estradiolo e noretindrone acetato a basso dosaggio per 24 settimane rispetto al placebo per quanto segue:
    o Funzionalit¿ misurata mediante il dominio relativo al dolore del questionario EHP-30;
    o Dismenorrea misurata mediante la scala NRS;
    o PGIC per la dismenorrea;
    o NMPP misurato mediante la scala NRS;
    o PGIC per il NMPP;
    o Dispareunia misurata mediante la scala NRS;
    o PGIC per la dispareunia;
    o Effetti funzionali correlati alla dispareunia (sB&B);
    o PGA per il dolore;
    o PGA per la funzionalit¿;
    o Qualit¿ della vita associata all¿endometriosi (domini dell¿EHP-30 relativi alla capacit¿ o incapacit¿ di controllo, al supporto sociale, al benessere emotivo e all'immagine di s¿);
    o Effetti funzionali correlati alla dismenorrea (sB&B);
    o Effetti funzionali correlati al NMPP (sB&B).
    o PGA per dismenorrea;
    o PGA per NMPP.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Pharmacogenomics
    Version: Raccolta opzionale di campioni per la farmacogenomica
    Date: 12/06/2017
    Title: NA
    Objectives: NA

    Farmacogenomica
    Versione: Raccolta opzionale di campioni per la farmacogenomica
    Data: 12/06/2017
    Titolo: NA
    Obiettivi: NA
    E.3Principal inclusion criteria
    1. Has voluntarily signed and dated the informed consent form prior to initiation of any screening or study-specific procedures;
    2. Is a premenopausal female aged 18 to 50 years old (inclusive) on the day of signing date of the informed consent form;
    3. By the patient's report, had 2 consecutive regular menstrual cycles
    (ie, 21 to 35 days in duration) immediately prior to Randomization. For
    patients who have washed off hormonal contraceptives, the 2 regular
    cycles must start after the first (withdrawal) bleeding following
    discontinuation of contraceptives;
    4. Has agreed to use only study-specified analgesic medications during
    the study and is not known to be intolerant to these;
    5. Has a diagnosis of endometriosis and has had, within 10 years prior to
    signing the informed consent form, surgical or direct visualization
    and/or histopathologic confirmation of endometriosis, for example,
    during a laparoscopy or laparotomy;
    6. During the Screening visit, the patient reports moderate, severe, or very severe pain during the most recent menses and for NMPP in the prior month;
    7. During the Run-In Period (Days R1 through 35), has at least 24 days of completed eDiary scores;
    8. During the Run-In Period (Days R1 through R35), has a dysmenorrhea
    NRS score >= 4.0 on at least 2 days AND
    a. Mean NMPP NRS score > =2.5 OR
    b. Mean NMPP NRS score >= 1.25 AND NMPP NRS score >= 5.0 on >=
    4.0 days;
    For patients with fewer than 3 dysmenorrhea scores during Days R1 -
    R35, dysmenorrhea scores from Days R36 – 70 will be included in the
    eligibility determination until a total of 3 dysmenorrhea scores from the
    Run-In Period are available.
    9. Has menstruated for at least 3 days during the Run-In Period (Days R1 through R35);
    10. Is not expected to undergo gynecological surgery or other surgical procedures for treatment of endometriosis (including ablation, shaving, or excision) during the study, including during the Follow-Up Period, and the patient does not desire such treatment during this time frame;
    11. Has a negative urine pregnancy test at the Screening visit and on the Baseline Day 1 visit;
    12. Agrees to use contraception during the study and for 30 days
    following the last dose of study drug. Specifically, agrees to use
    nonhormonal contraception as described in Section 4.7 consistently
    during the Screening Period, Run-In Period, and the Randomized
    Treatment Period and for 30 days following treatment discontinuation.
    However, the patient is not required to use the specified nonhormonal
    contraception if she:
    a. Has a sexual partner(s) who was vasectomized at least 6 months prior to the Screening Period;
    b. Had a bilateral tubal occlusion (including ligation and blockage methods such as Essure™), at least 6 months prior to the Screening visit (patients with Essure must have prior confirmation of tubal occlusion by hysterosalpingogram and no evidence of “post-Essure syndrome” in the investigator’s opinion);
    c. Is not sexually active with men; periodic sexual relationship(s) with men requires the use of nonhormonal contraception as noted above; or
    d. Practices total abstinence from sexual intercourse as her preferred lifestyle. Periodic abstinence is not acceptable
    13. Has an adequate endometrial (aspiration) biopsy performed during the Screening visit with results showing no clinically significant endometrial pathology (hyperplasia, polyp, or endometrial cancer);
    Note 1: Patients for whom polyps are detected on the biopsy but are either not evident on ultrasound or < 2.0 cm by ultrasound are eligible;
    Note 2: endometrial biopsies that were performed or repeated during the Run-In Period and meet criteria are
    acceptable;
    14. If > =39 years of age at the time of the Screening, has a normal mammogram (Breast Imaging Reporting and Data System category 1 to 2 or equivalent; see Appendix 1 of Protocol) during the Run-In Period or within 6 months prior to the Run-In Period.
    1. Le pazienti devono aver volontariamente firmato e datato il modulo di consenso informato prima dell’inizio di qualunque procedura di screening o procedura specifica dello studio;
    2. Devono essere donne in pre-menopausa, di età compresa tra 18 e 50 anni (inclusi) alla data di apposizione della firma sul modulo di consenso informato;
    3. Devono aver riferito di aver avuto 2 cicli mestruali consecutivi regolari (ovvero, di durata da 21 a 35 giorni) immediatamente prima della randomizzazione. Per le pazienti che hanno eliminato i contraccettivi ormonali, i 2 cicli regolari devono iniziare dopo il primo sanguinamento (ritiro) a seguito della sospensione dei contraccettivi;
    4. Devono aver accettato di utilizzare esclusivamente i farmaci analgesici specifici dello studio durante lo studio e non devono avere un'intolleranza nota a tali farmaci;
    5. Devono aver ricevuto una diagnosi di endometriosi e devono aver avuto, nei dieci anni precedenti la firma del modulo di consenso informato, una visualizzazione chirurgica o diretta, e/o una conferma istopatologica di endometriosi, per esempio durante laparoscopia o laparotomia;
    6. Durante la Visita di screening, le pazienti devono riportare dolore moderato, grave o molto grave durante le mestruazioni più recenti e per il dolore pelvico non mestruale (NMPP) nel mese precedente;
    7. Durante i Giorni da R1 a R35 del Periodo di inserimento (Giorni R1-R35) i punteggi dell’eDiary devono essere stati completati almeno per 24 giorni;
    8. Durante i Giorni da R1 a R35 del Periodo di inserimento (Giorni R1-R35), il punteggio della scala NRS per la dismenorrea deve essere >=4,0 per almeno 2 giorni E
    a. Il punteggio medio della scala NRS per il NMPP deve essere >=2,5, OPPURE
    b. Il punteggio medio della scala NRS per il NMPP deve essere >=1,25 E il punteggio della scala NRS per il NMPP deve essere >=5,0 per un periodo >=4 giorni;
    Per le pazienti con meno di 3 punteggi di dismenorrea durante i giorni R1 - R35, i punteggi di dismenorrea dai giorni R36 - 70 saranno inclusi nella determinazione dell'idoneità fino a quando non saranno disponibili un totale di 3 punteggi di dismenorrea del periodo di inserimento.
    9. Devono avere le mestruazioni per almeno 3 giorni durante il Periodo di inserimento (Giorni R1-R35);
    10. Non si prevede si sottopongano a chirurgia ginecologica o altra procedura chirurgica per il trattamento dell’endometriosi (compresa ablazione, raschiamento o escissione) durante lo studio, né durante il Periodo di follow-up e le pazienti non desiderano sottoporsi a tali trattamenti durante quest’arco di tempo;
    11. Negatività al test di gravidanza sulle urine alla Visita di screening e alla Visita basale del Giorno 1;
    12. Devono accettare di utilizzare un metodo contraccettivo durante lo studio e per 30 giorni dopo l’ultima dose del farmaco in studio. Nello specifico, devono accettare di utilizzare un metodo contraccettivo non ormonale come descritto nella Sezione 4.7 in maniera sistematica durante il Periodo di screening, il Periodo di inserimento e il Periodo di trattamento randomizzato e per 30 giorni in seguito all’interruzione del trattamento.
    (per altri dettagli fare riferimento al protocollo)
    13. Sono state sottoposte a biopsia endometriale (aspirazione) adeguata durante la Visita di screening o nel Periodo di inserimento o nei 6 mesi prima dello screening, i cui risultati hanno mostrato l'assenza di patologie endometriali significative da un punto di vista clinico (iperplasia, polipi o carcinoma endometriale);
    Nota 1: Le pazienti per cui viene rilevata la presenza di polipi alla biopsia che non sono evidenti all’ecografia o la cui dimensione tramite ecografia risulta <2,0 cm sono idonee; Nota 2: le biopsie endometriali che sono state eseguite o ripetute durante il Periodo di inserimento e che soddisfano i criteri sono accettabili;
    (per altri criteri fare riferimento al protocollo)
    E.4Principal exclusion criteria
    1. Has a history of chronic pelvic pain that is not caused by endometriosis
    2. Has had 4 or more prior laparoscopic or open abdominal or pelvic ,
    surgical procedure for endometriosis;
    3. During the Run-In Period, reports NMPP is “much better” on the PGIC for NMPP
    4. Has a transvaginal ultrasound during the Screening visit demonstrating pathology other than endometriosis that could be responsible for or contributing to the patient’s chronic pelvic pain or a clinically significant gynecological disorder determined by the investigator to require further evaluation and/or treatment during the study
    5. Has any chronic pain or frequently recurring pain condition, other than endometriosis, that is treated with opioids or requires analgesics for > 7 days per month
    6. Has had surgical procedure for treatment of endometriosis within the
    3 months prior to the Screening visit
    7. Has a history of previous non-response of NMPP or dysmenorrhea to GnRH agonists, GnRH antagonists, depot medroxyprogesterone acetate, or aromatase inhibitors based on patient’s report or treating physician’s assessment of chart documentation;
    8. Has unexplained vaginal bleeding outside of the patient’s regular menstrual period
    9. Has a weight that exceeds the weight limit of the DXA scanner
    10. Has bone mineral density z-score < -2.0 at spine, total hip, or femoral neck during the Run-In Period
    11. Has a gastrointestinal disorder affecting absorption or gastrointestinal motility
    12. Has used, is using or is anticipated to use prohibited medications;
    13. Patients receiving selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, or tricyclic antidepressants that have been recently started or undergone recent dose changes. Patients who have been on stable doses for at least 3 months and are anticipated to remain on stable doses during the study (including the Run-In Period) may be enrolled
    14. Has a history of or currently has osteoporosis, or other metabolic bone disease, hyperparathyroidism, hyperprolactinemia, hyperthyroidism, anorexia nervosa, or low traumatic or atraumatic fracture. A history of successfully treated hyperparathyroidism, hyperprolactinemia, or hyperthyroidism is allowed
    15. Has a history of the use of bisphosphonates, calcitonin, calcitriol, ipriflavone, teriparatide, denosumab, or any medication other than calcium and vitamin D preparations to treat bone mineral density loss
    16. Has a systemic autoimmune disease
    17. Has any contraindication to treatment with low-dose estradiol and norethindrone acetate,
    18. Has jaundice or known current active liver disease from any cause including hepatitis A (hepatitis A virus [HAV] immunoglobulin M [IgM]), hepatitis B (hepatitis B virus surface antigen [HBsAg]), or hepatitis C (hepatitis C virus [HCV] antibody [Ab] positive, confirmed by HCV ribonucleic acid [RNA])
    19. On the most recently documented Papanicolaou test, has any of the following cervical pathology: high-grade cervical neoplasia, atypical glandular cells, atypical endocervical cells, or atypical squamous cells favoring high grade. Of note, patients with atypical squamous cells of undetermined significance and low-grade cervical neoplasia may be included in the study if high-risk human papilloma virus testing is negative or if deoxyribonucleic acid (DNA) testing for human papilloma virus 16 and 18 is negative
    20. Has any clinical laboratory abnormalities during the Screening or Run-In Period
    21. Has clinically significant cardiovascular disease
    22. Has been a participant in an investigational drug or device study within the 1 month prior to the Screening visit
    23. Has a history of clinically significant condition(s)
    24. Is currently pregnant or lactating, or intends to become pregnant or to donate ova during the study period or within 2 months after the last dose of study drug
    (for further criteria please see the protocol)
    1. Anamnesi positiva per dolore pelvico cronico non causato da endometriosi (ad es., vaginismo, infezione pelvica cronica, idrosalpinge sintomatica, cisti dermoide sintomatica, corpo luteo sintomatico, cisti ovarica persistente sintomatica, torsione ovarica sospetta o disturbi del pavimento pelvico);
    Pazienti che siano state precedentemente sottoposte a 4 o più laparoscopie o ad altre procedure chirurgiche aperte addominali o pelviche, per l’endometriosi;
    3. Pazienti che durante il Periodo di inserimento segnalino che il NMPP è “decisamente migliorato” sulla scala PGIC per il NMPP;
    4. Pazienti che siano state sottoposte a ecografia transvaginale durante lo Screening o il Periodo di inserimento con evidenze di una patologia diversa dall’endometriosi che potrebbe essere responsabile del dolore pelvico cronico della paziente o che potrebbe contribuire ad esso oppure che dimostra la presenza di un disordine ginecologico clinicamente significativo che, secondo lo sperimentatore, necessita di ulteriore valutazione e/o trattamento durante lo studio.
    Nota 1: Il contrasto con soluzione fisiologica o gel non è richiesto come procedura di routine. L’uso di tale mezzo di contrasto è necessario solo quando l’endometrio non può essere valutato oppure quando vi sono dei riscontri ambigui e potenzialmente esclusivi sull’ecografia transvaginale o la biopsia endometriale (ad es., masse intrauterine sospette, riscontri endometriali equivoci, ecc.);
    Nota 2: sono accettabili le ecografie transvaginali ripetute durante il Periodo di inserimento che soddisfano i criteri;
    5. Pazienti con qualunque tipo di dolore cronico o stato di dolore particolarmente ricorrente, diverso dall’endometriosi, che è trattato con oppioidi o richiede l’uso di analgesici per ¿7 giorni al mese;
    6. Pazienti che siano state sottoposte a procedura chirurgica per il trattamento dell’endometriosi nei 3 mesi antecedenti la Visita di screening;
    7. Pazienti che abbiano avuto in passato una mancata risposta del NMPP o della dismenorrea ad agonisti o antagonisti dell’ormone di rilascio delle gonadotropine (GnRH), oppure a medrossiprogesterone acetato depot sulla base di quanto segnalato dalla paziente o sulla base della valutazione della cartella clinica effettuata dal medico curante. Nota: Una risposta parziale a questi farmaci non porta all’esclusione;
    8. Pazienti che abbiano sanguinamenti vaginali inspiegabili al di fuori del loro regolare periodo mestruale, definiti come sanguinamenti che si verificano per un periodo >4 giorni al di fuori dell’intervallo abituale di durata delle mestruazioni della paziente;
    9. Pazienti che abbiano un peso eccedente il limite di peso dello scanner DXA oppure che abbiano una condizione che precluda una misurazione DXA adeguata a livello del rachide lombare o del femore prossimale (ad es., sostituzione bilaterale dell’anca, materiale protesico nel rachide lombare);
    10. Pazienti che abbiano uno z-score relativo alla densità minerale ossea <-2,0 per la colonna vertebrale, l'anca totale o il collo femorale durante il Periodo di inserimento;
    11. Pazienti che abbiano un disturbo gastrointestinale che influisce sull’assorbimento o sulla motilità gastrointestinale;
    12. Pazienti che abbiano utilizzato, che utilizzano o che prevedono di utilizzare farmaci proibiti (consultare la Sezione 5.10 per i farmaci proibiti e i relativi periodi di esclusione);
    13. Pazienti che stiano ricevendo inibitori selettivi della ricaptazione della serotonina, inibitori della ricaptazione della serotonina e della noradrenalina o antidepressivi triciclici, la cui assunzione sia stata iniziata di recente o per i quali sia stata effettuata una recente modifica della dose. Le pazienti in trattamento con dosi stabili per almeno 3 mesi e che si prevede continuino ad assumere dosi stabili durante lo studio (compreso il Periodo di inserimento) possono essere arruolate;
    (per altri criteri fare riferimento al protocollo)
    E.5 End points
    E.5.1Primary end point(s)
    1. Proportion of responders at the Week 24/EOT pain assessment period, based on their dysmenorrhea Numerical Rating Scale (NRS) scores
    recorded in a daily electronic diary (eDiary), in the relugolix 40 mg group co-administered with lowdose hormonal add-back therapy for 24 weeks versus placebo;
    2.Proportion of responders at the Week 24/EOT pain assessment period, based on their NMPP NRS scores recorded in a daily eDiary, in the
    relugolix 40 mg group co-administered with low-dose hormonal addback therapy for 24 weeks versus placebo.
    • Percentuale di responder al periodo di valutazione del dolore della Settimana 24/EOT, sulla base dei punteggi della scala NRS per la dismenorrea riportati sull’eDiary giornaliero, nel gruppo in cui relugolix 40 mg viene somministrato in modo concomitante con la add-back therapy a basso dosaggio per 24 settimane vs. placebo;
    • Percentuale di responder al periodo di valutazione del dolore della Settimana 24/EOT, sulla base dei punteggi della scala NRS per il NMPP riportati sull’eDiary giornaliero, nel gruppo in cui relugolix 40 mg viene somministrato in modo concomitante con la add-back therapy a basso dosaggio per 24 settimane vs. placebo;
    E.5.1.1Timepoint(s) of evaluation of this end point
    week 24
    settimana 24
    E.5.2Secondary end point(s)
    -secondary endpoints will be assessed comparing Group A with Group C:
    -Change from Baseline at Week 24 in the EHP-30 Pain Domain scores in
    the relugolix 40 mg group co-administered with low-dose hormonal
    addback therapy for 24 weeks versus placebo;
    Change from Baseline to Week 24/EOT in the mean dysmenorrhea NRS
    score;
    - Proportion of patients who are better or much better on the PGIC for
    dysmenorrhea at Week 24/EOT;
    - Change from Baseline to Week 24/EOT in the mean NMPP NRS score;
    - Proportion of patients who are better or much better on the PGIC for
    NMPP at Week 24/EOT;
    - Change from Baseline to Week 24/EOT in the mean dyspareunia NRS
    scores.
    - Proportion of patients who are better or much better on the PGIC for
    dyspareunia at Week 24/EOT;
    - Change from Baseline to Week 24/EOT in the mean dyspareunia
    functional impairment on the sB&B scale;
    - Change from Baseline to Week 24/EOT in severity scores on the PGA
    for pain;
    - Change from Baseline to Week 24/EOT in function impairment on the
    PGA for function;
    - Change from Baseline to Week 24/EOT in each of the non-pain EHP-30
    domains (Control and Powerlessness, Social Support, Emotional Well-
    Being, and Self-Image);
    - Change from Baseline to Week 24/EOT in the mean dysmenorrhea
    functional impairment on the sB&B scale;
    - Change from Baseline to Week 24/EOT in the mean NMPP functional
    impairment on the sB&B scale.
    -The following secondary endpoints will be assessed comparing Group B
    with Group C:
    - Proportion of responders at the Week 24/EOT pain assessment period,
    based on their dysmenorrhea NRS scores recorded in a daily eDiary;
    - Proportion of responders at the Week 24/EOT pain assessment period,
    based on their NMPP NRS scores recorded in a daily eDiary.
    - Change from Baseline at Week 24/EOT in the EHP-30 Pain Domain
    scores.
    ¿ Cambiamento dal basale alla Settimana 24 nei punteggi del dominio relativo al dolore dell¿EHP-30 nel gruppo in cui relugolix 40 mg viene somministrato in modo concomitante con la add-back therapy a basso dosaggio per 24 settimane vs. placebo;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nel punteggio medio della scala NRS per la dismenorrea;
    ¿ Percentuale di pazienti che riferiscono uno stato ¿migliore¿ o ¿molto migliore¿ sul PGIC per la dismenorrea alla Settimana 24/EOT;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nel punteggio medio della scala NRS per il dolore pelvico non mestruale (NMPP);
    ¿ Percentuale di pazienti che riportano uno stato ¿migliore¿ o ¿molto migliore¿ sul PGIC per il NMPP alla Settimana 24/EOT;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nel punteggio medio della scala NRS per la dispareunia;
    ¿ Percentuale di pazienti che riportano uno stato ¿migliore¿ o ¿molto migliore¿ sul PGIC per la dispareunia alla Settimana 24/EOT;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nella compromissione funzionale media per soggetti con dispareunia sulla scala sB&B;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nei punteggi relativi alla gravit¿ sul PGA per il dolore;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nella compromissione funzionale sul PGA per la funzionalit¿;
    ¿ Cambiamento dal basale alla Settimana 24/EOT in ciascuno dei domini dell¿EHP-30 non correlati al dolore (capacit¿ e incapacit¿ di controllo, supporto sociale, benessere emotivo e immagine di s¿);
    ¿ Cambiamento dal basale alla Settimana 24/EOT nella compromissione funzionale media per soggetti con dismenorrea sulla scala sB&B;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nella compromissione funzionale media per soggetti con NMPP sulla scala sB&B;
    ¿ Percentuale di responder al periodo di valutazione del dolore della Settimana 24/EOT, sulla base dei punteggi della scala NRS per la dismenorrea riportati su un eDiary giornaliero;
    ¿ Percentuale di responder al periodo di valutazione del dolore della Settimana 24/EOT, sulla base dei punteggi della scala NRS per il NMPP riportati su un eDiary giornaliero;
    ¿ Cambiamento dal basale alla Settimana 24/EOT nei punteggi del dominio relativo al dolore dell¿EHP-30.
    E.5.2.1Timepoint(s) of evaluation of this end point
    week 24
    setimana 24
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned15
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA74
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Brazil
    Canada
    Chile
    Czechia
    Georgia
    Italy
    New Zealand
    Poland
    Romania
    Sweden
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months9
    E.8.9.1In the Member State concerned days16
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months9
    E.8.9.2In all countries concerned by the trial days16
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 600
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state38
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 240
    F.4.2.2In the whole clinical trial 600
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Eligible patients, including women randomized to placebo, will be offered the opportunity to enroll in a 28-week open-label extension study where patients will receive relugolix co-administered with low-dose estradiol and norethindrone acetate. Patients who do not enroll into the extension study will have a Follow-Up visit approximately 30 days after the patient¿s last dose of study drug.
    Alle pazienti idonee, comprese le donne randomizzate a ricevere placebo, sarà data la possibilità di arruolarsi in uno studio di estensione in aperto di 28 settimane, in cui la pazienti riceveranno relugolix somministrato in concomitanza con estradiolo e noretindrone acetato a basso dosaggio. Le pazienti che non si arruolano allo studio di estensione saranno sottoposte a Visita di follow-up circa 30 giorni dopo l’assunzione dell’ultima dose del farmaco dello studio da parte della paziente.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-01-11
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-09-21
    P. End of Trial
    P.End of Trial StatusCompleted
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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