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    Clinical Trial Results:
    SPIRIT EXTENSION: An International Phase 3 Open-Label, Single-Arm, Safety and Efficacy Extension Study to Evaluate Relugolix Co-Administered with Low-Dose Estradiol and Norethindrone Acetate in Women with Endometriosis-Associated Pain

    Summary
    EudraCT number
    2017-004066-10
    Trial protocol
    GB   ES   HU   BE   FI   SE   PL   CZ   BG   PT   IT   RO  
    Global end of trial date
    23 Jan 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    20 Aug 2023
    First version publication date
    20 Aug 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    MVT-601-3103
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03654274
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    IND: 076642
    Sponsors
    Sponsor organisation name
    Myovant Sciences GmbH
    Sponsor organisation address
    Viaduktstrasse 8, Basel, Switzerland, 4051
    Public contact
    VP of Clinical Operations, Myovant Sciences GmbH, +1 (650)238 0250, SPIRIT@myovant.com
    Scientific contact
    VP of Clinical Operations, Myovant Sciences GmbH, +1 (650)238 0250, SPIRIT@myovant.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    21 Jul 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    16 Dec 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    23 Jan 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate long-term efficacy of relugolix 40 mg once daily co administered with low-dose estradiol and norethindrone acetate for up to 52 and 104 weeks, among patients who previously completed a 24-week treatment period in one of the parent studies (MVT-601-3101 or MVT 601-3102), on endometriosis-associated pain.
    Protection of trial subjects
    This study was conducted in accordance with International Council for Harmonisation (ICH) E6 (R2) (Guideline for Good Clinical Practice [GCP]), applicable patient privacy requirements, and the ethical principles outlined in the Declaration of Helsinki 2013. Additionally, the study was conducted in accordance with the United States (US) Code of Federal Regulations, the European Union Clinical Trials Directive, and applicable local/regional regulations and guidelines regarding the conduct of clinical studies.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 May 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 297
    Country: Number of subjects enrolled
    Portugal: 7
    Country: Number of subjects enrolled
    Romania: 31
    Country: Number of subjects enrolled
    Spain: 2
    Country: Number of subjects enrolled
    Belgium: 8
    Country: Number of subjects enrolled
    Bulgaria: 29
    Country: Number of subjects enrolled
    Czechia: 28
    Country: Number of subjects enrolled
    Finland: 5
    Country: Number of subjects enrolled
    Hungary: 24
    Country: Number of subjects enrolled
    Italy: 17
    Country: Number of subjects enrolled
    United States: 147
    Country: Number of subjects enrolled
    Argentina: 34
    Country: Number of subjects enrolled
    Australia: 11
    Country: Number of subjects enrolled
    Brazil: 41
    Country: Number of subjects enrolled
    Canada: 6
    Country: Number of subjects enrolled
    Chile: 5
    Country: Number of subjects enrolled
    Georgia: 7
    Country: Number of subjects enrolled
    New Zealand: 8
    Country: Number of subjects enrolled
    South Africa: 32
    Country: Number of subjects enrolled
    Ukraine: 63
    Worldwide total number of subjects
    802
    EEA total number of subjects
    448
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    802
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    All participants who completed their participation in one of the pivotal studies (MVT-601-3101 or MVT-601-3102) were eligible to enroll in this study. Due to data integrity concerns at 1 US site, 3 patients (1 relugolix + E2/NETA; 2 Placebo) were excluded from efficacy and safety analyses, but included in demographic and disposition tables.

    Pre-assignment
    Screening details
    The study results were presented by pivotal study treatment but all the participants only received relugolix plus Estradiol (E2)/Norethindrone Acetate (NETA). Three participants (1 in the relugolix plus E2/NETA group; 2 in the placebo group) were excluded due to GCP noncompliance and no data is reported for these participants.

    Period 1
    Period 1 title
    Overall Period
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Relugolix Plus E2/NETA (Group A)
    Arm description
    Relugolix 40 mg once daily co-administered with E2 (1 mg) and NETA (0.5 mg) for 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.
    Arm type
    Experimental

    Investigational medicinal product name
    Relugolix
    Investigational medicinal product code
    Other name
    TAK-385, MVT-601
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Relugolix 40-mg tablet administered orally once daily.

    Investigational medicinal product name
    Estradiol/Norethindrone acetate
    Investigational medicinal product code
    Other name
    E2/NETA, low-dose hormonal add-back
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Capsule containing co-formulated tablet of E2 (1 mg)/NETA (0.5 mg) administered orally once daily.

    Arm title
    Relugolix Plus Delayed E2/NETA (Group B)
    Arm description
    Relugolix 40 mg monotherapy (once daily) for 12 weeks, followed by oral relugolix 40 mg once daily coadministered with E2 (1mg) and NETA (0.5 mg) for 12 weeks in the pivotal study and Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.
    Arm type
    Experimental

    Investigational medicinal product name
    Relugolix
    Investigational medicinal product code
    Other name
    TAK-385, MVT-601
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Relugolix 40-mg tablet administered orally once daily.

    Investigational medicinal product name
    Estradiol/Norethindrone acetate
    Investigational medicinal product code
    Other name
    E2/NETA, low-dose hormonal add-back
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Capsule containing co-formulated tablet of E2 (1 mg)/NETA (0.5 mg) administered orally once daily.

    Arm title
    Placebo (Group C)
    Arm description
    Relugolix placebo co-administered with E2/NETA placebo for up to 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.
    Arm type
    Experimental

    Investigational medicinal product name
    Relugolix
    Investigational medicinal product code
    Other name
    TAK-385, MVT-601
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Relugolix 40-mg tablet administered orally once daily.

    Investigational medicinal product name
    Estradiol/Norethindrone acetate
    Investigational medicinal product code
    Other name
    E2/NETA, low-dose hormonal add-back
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Capsule containing co-formulated tablet of E2 (1 mg)/NETA (0.5 mg) administered orally once daily.

    Number of subjects in period 1
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Started
    278
    247
    277
    Completed
    172
    155
    175
    Not completed
    106
    92
    102
         Consent withdrawn by subject
    46
    25
    33
         Adverse event, non-fatal
    19
    23
    24
         Other
    27
    -
    32
         Pregnancy
    2
    2
    1
         Unspecified
    -
    29
    -
         Lost to follow-up
    8
    6
    5
         Lack of efficacy
    4
    5
    7
         Protocol deviation
    -
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Relugolix Plus E2/NETA (Group A)
    Reporting group description
    Relugolix 40 mg once daily co-administered with E2 (1 mg) and NETA (0.5 mg) for 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group title
    Relugolix Plus Delayed E2/NETA (Group B)
    Reporting group description
    Relugolix 40 mg monotherapy (once daily) for 12 weeks, followed by oral relugolix 40 mg once daily coadministered with E2 (1mg) and NETA (0.5 mg) for 12 weeks in the pivotal study and Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group title
    Placebo (Group C)
    Reporting group description
    Relugolix placebo co-administered with E2/NETA placebo for up to 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C) Total
    Number of subjects
    278 247 277 802
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0
        Newborns (0-27 days)
    0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    278 247 277 802
        From 65-84 years
    0 0 0 0
        85 years and over
    0 0 0 0
        Between 18 and 65 years
    0 0 0 0
    Gender categorical
    Units: Subjects
        Female
    278 247 277 802
        Male
    0 0 0 0
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    27 31 42 100
        Not Hispanic or Latino
    249 215 233 697
        Unknown or Not reported
    2 1 2 5
    Race/Ethnicity, Customized
    Number of participants based on their race.
    Units: Subjects
        American Indian or Alaska Native
    1 1 0 2
        Asian
    0 1 0 1
        Black or African American
    17 7 13 37
        Native Hawaiian or Other Pacific Islander
    0 0 1 1
        White
    254 236 248 738
        Other
    1 0 8 9
        Multiple
    4 2 5 11
        Not reported
    1 0 2 3
    Time Since Surgical Diagnosis of Endometriosis
    Units: Years
        arithmetic mean (standard deviation)
    4.0 ± 3.52 4.7 ± 4.00 3.9 ± 3.24 -
    Dysmenorrhea Numerical Rating Scale Score at Baseline
    Assessed using an numerical rating scale (NRS) score (11-point scale) for pain recorded daily in an electronic diary. Higher NRS score means worse condition (0 = no pain to 10 = pain as bad as you can imagine).
    Units: score on a scale
        arithmetic mean (standard deviation)
    7.1 ± 1.66 7.0 ± 1.65 7.2 ± 1.63 -
    Nonmenstrual Pelvic Pain Numerical Rating Scale Score at Baseline
    Assessed using an numerical rating scale (NRS) score (11-point scale) for pain recorded daily in an electronic diary. Higher NRS score means worse condition (0 = no pain to 10 = pain as bad as you can imagine).
    Units: score on a scale
        arithmetic mean (standard deviation)
    5.7 ± 1.93 5.5 ± 1.98 5.7 ± 1.91 -
    Bone Mineral Density Lumbar Spine L1- L4
    Units: g/cm^2
        arithmetic mean (standard deviation)
    1.14 ± 0.163 1.14 ± 0.144 1.14 ± 0.149 -
    Bone Mineral Density Total Hip
    Units: g/cm^2
        arithmetic mean (standard deviation)
    0.98 ± 0.133 0.97 ± 0.120 0.98 ± 0.123 -
    Bone Mineral Density Femoral Neck
    Units: g/cm^2
        arithmetic mean (standard deviation)
    0.93 ± 0.157 0.92 ± 0.136 0.93 ± 0.151 -

    End points

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    End points reporting groups
    Reporting group title
    Relugolix Plus E2/NETA (Group A)
    Reporting group description
    Relugolix 40 mg once daily co-administered with E2 (1 mg) and NETA (0.5 mg) for 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group title
    Relugolix Plus Delayed E2/NETA (Group B)
    Reporting group description
    Relugolix 40 mg monotherapy (once daily) for 12 weeks, followed by oral relugolix 40 mg once daily coadministered with E2 (1mg) and NETA (0.5 mg) for 12 weeks in the pivotal study and Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group title
    Placebo (Group C)
    Reporting group description
    Relugolix placebo co-administered with E2/NETA placebo for up to 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Primary: Percentage Of Participants Who Meet The Dysmenorrhea Responder Criteria At Week 52

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    End point title
    Percentage Of Participants Who Meet The Dysmenorrhea Responder Criteria At Week 52 [1]
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. A participant was defined as a responder if the NRS score for dysmenorrhea declined from baseline to Week 52 by at least 2.8 points without increased use of protocol-specified analgesics for pelvic pain at Week 52 relative to baseline. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine.
    End point type
    Primary
    End point timeframe
    Week 52
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The responder rate and two-sided 95% CI will be presented by the pivotal phase 3 study treatment group. No treatment comparisons will be performed for this extension study.
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    277
    247
    275
    Units: percentage of participants
        number (confidence interval 95%)
    84.8 (80.06 to 88.85)
    82.2 (76.83 to 86.75)
    75.6 (70.12 to 80.59)
    No statistical analyses for this end point

    Primary: Percentage Of Participants Who Meet The Nonmenstrual Pelvic Pain Responder Criteria At Week 52

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    End point title
    Percentage Of Participants Who Meet The Nonmenstrual Pelvic Pain Responder Criteria At Week 52 [2]
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. A participant was defined as a responder if the NRS score for NMPP declined from baseline to Week 52 by at least 2.1 points without increased use of protocol-specified analgesics for pelvic pain at Week 52 relative to baseline. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine.
    End point type
    Primary
    End point timeframe
    Week 52
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The responder rate and two-sided 95% CI will be presented by the pivotal phase 3 study treatment group. No treatment comparisons will be performed for this extension study.
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    277
    247
    275
    Units: percentage of participants
        number (confidence interval 95%)
    73.6 (68.04 to 78.74)
    70.4 (64.33 to 76.06)
    68.0 (62.13 to 73.47)
    No statistical analyses for this end point

    Primary: Percentage Of Participants Who Meet The Dysmenorrhea Responder Criteria At Week 104

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    End point title
    Percentage Of Participants Who Meet The Dysmenorrhea Responder Criteria At Week 104 [3]
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. A participant was defined as a responder if the NRS score for dysmenorrhea declined from baseline to Week 104 by at least 2.8 points without increased use of protocol-specified analgesics for pelvic pain at Week 104 relative to baseline. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine.
    End point type
    Primary
    End point timeframe
    Week 104
    Notes
    [3] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: .
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    277
    247
    275
    Units: Percentage of participants
        number (confidence interval 95%)
    84.8 (80.06 to 88.85)
    83.0 (77.72 to 87.46)
    80.4 (75.17 to 84.89)
    No statistical analyses for this end point

    Primary: Percentage Of Participants Who Meet The Nonmenstrual Pelvic Pain Responder Criteria At Week 104

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    End point title
    Percentage Of Participants Who Meet The Nonmenstrual Pelvic Pain Responder Criteria At Week 104 [4]
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. A participant was defined as a responder if the NRS score for NMPP declined from baseline to Week 104 by at least 2.1 points without increased use of protocol-specified analgesics for pelvic pain at Week 104 relative to baseline. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine.
    End point type
    Primary
    End point timeframe
    Week 104
    Notes
    [4] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The responder rate and two-sided 95% CI will be presented by the pivotal phase 3 study treatment group. No treatment comparisons will be performed for this extension study.
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    277
    247
    275
    Units: Percentage of participants
        number (confidence interval 95%)
    75.8 (70.33 to 80.74)
    71.7 (65.60 to 77.19)
    73.1 (67.44 to 78.24)
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Endometriosis Health Profile (EHP)-30 Pain Domain Scores At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Endometriosis Health Profile (EHP)-30 Pain Domain Scores At Week 52
    End point description
    Assessed using the pain domain of the EHP-30 questionnaire. The EHP-30 questionnaire was completed on an electronic tablet (eTablet) device. Participants reported the frequency (never, rarely, sometimes, often, and always) with which they had difficulty with activities such as standing, sitting, walking, sleeping, and performing jobs around the house because of pain. The Pain Domain normalized scores ranged from 0 to 100, with higher scores denoting greater functional impact of pain. The least squares (LS) mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    232
    207
    229
    Units: score on a scale
        least squares mean (standard error)
    -37.7 ± 1.34
    -36.1 ± 1.37
    -35.1 ± 1.32
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Endometriosis Health Profile (EHP)-30 Pain Domain Scores At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Endometriosis Health Profile (EHP)-30 Pain Domain Scores At Week 104
    End point description
    Assessed using the pain domain of the EHP-30 questionnaire. The EHP-30 questionnaire was completed on an electronic tablet (eTablet) device. Participants reported the frequency (never, rarely, sometimes, often, and always) with which they had difficulty with activities such as standing, sitting, walking, sleeping, and performing jobs around the house because of pain. The Pain Domain normalized scores ranged from 0 to 100, with higher scores denoting greater functional impact of pain. The least squares (LS) mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    167
    151
    173
    Units: Score on a scale
        least squares mean (standard error)
    -41.3 ± 1.33
    -38.9 ± 1.36
    -37.7 ± 1.29
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Who Have A Reduction Of At Least 20 Points In The EHP-30 Pain Domain Scores From The Pivotal Phase 3 Study Baseline At Week 52

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    End point title
    Percentage Of Participants Who Have A Reduction Of At Least 20 Points In The EHP-30 Pain Domain Scores From The Pivotal Phase 3 Study Baseline At Week 52
    End point description
    Assessed using the Pain Domain of the EHP-30 questionnaire. The EHP-30 questionnaire was completed on an electronic tablet (eTablet) device. Participants reported the frequency (never, rarely, sometimes, often, and always) with which they had difficulty with activities such as standing, sitting, walking, sleeping, and performing jobs around the house because of pain. The Pain Domain normalized scores ranged from 0 to 100, with higher scores denoting greater functional impact of pain.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    232
    207
    229
    Units: Percentage of participants
        number (confidence interval 95%)
    83.6 (78.22 to 88.14)
    81.2 (75.16 to 86.25)
    79.5 (73.66 to 84.51)
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Who Have A Reduction Of At Least 20 Points In The EHP-30 Pain Domain Scores From The Pivotal Phase 3 Study Baseline At Week 104

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    End point title
    Percentage Of Participants Who Have A Reduction Of At Least 20 Points In The EHP-30 Pain Domain Scores From The Pivotal Phase 3 Study Baseline At Week 104
    End point description
    Assessed using the Pain Domain of the EHP-30 questionnaire. The EHP-30 questionnaire was completed on an electronic tablet (eTablet) device. Participants reported the frequency (never, rarely, sometimes, often, and always) with which they had difficulty with activities such as standing, sitting, walking, sleeping, and performing jobs around the house because of pain. The Pain Domain normalized scores ranged from 0 to 100, with higher scores denoting greater functional impact of pain.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    167
    151
    173
    Units: Percentage of participants
        number (confidence interval 95%)
    88.6 (82.80 to 93.01)
    85.4 (78.78 to 90.64)
    86.1 (80.06 to 90.90)
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Dysmenorrhea NRS Score At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Dysmenorrhea NRS Score At Week 52
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    204
    233
    Units: Score on a scale
        least squares mean (standard error)
    -5.9 ± 0.15
    -5.7 ± 0.16
    -5.3 ± 0.15
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Dysmenorrhea NRS Score At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Dysmenorrhea NRS Score At Week 104
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    129
    112
    124
    Units: Score on a scale
        least squares mean (standard error)
    -5.9 ± 0.17
    -5.7 ± 0.18
    -5.6 ± 0.17
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Who Are "Better" Or "Much Better" On The Patient Global Impression Of Change (PGIC) For Dysmenorrhea At Week 52

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    End point title
    Percentage Of Participants Who Are "Better" Or "Much Better" On The Patient Global Impression Of Change (PGIC) For Dysmenorrhea At Week 52
    End point description
    The PGIC for dysmenorrhea is a 1-item questionnaire designed to assess participant’s impression of change in the severity of pain during their menstrual cycle. The questionnaire used a 7-point response scale: much better, better, a little better, the same, a little worse, worse, or much worse.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    221
    202
    230
    Units: Percentage of participants
        number (confidence interval 95%)
    89.1 (84.27 to 92.92)
    87.1 (81.71 to 91.42)
    83.0 (77.56 to 87.66)
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean NMPP NRS Score At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean NMPP NRS Score At Week 52
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    204
    233
    Units: Score on a scale
        least squares mean (standard error)
    -3.6 ± 0.15
    -3.4 ± 0.16
    -3.4 ± 0.15
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean NMPP NRS Score At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean NMPP NRS Score At Week 104
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. Participants rated their pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    129
    112
    124
    Units: Score on a scale
        least squares mean (standard error)
    -4.0 ± 0.16
    -3.5 ± 0.17
    -3.8 ± 0.16
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Overall Pelvic Pain NRS Score At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Overall Pelvic Pain NRS Score At Week 52
    End point description
    Assessed using an NRS score (11-point scale) for overall pain recorded daily in an electronic diary. Participants rated their overall pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    204
    233
    Units: Score on a scale
        least squares mean (standard error)
    -3.9 ± 0.15
    -3.6 ± 0.16
    -3.6 ± 0.15
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Overall Pelvic Pain NRS Score At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Overall Pelvic Pain NRS Score At Week 104
    End point description
    Assessed using an NRS score (11-point scale) for overall pain recorded daily in an electronic diary. Participants rated their overall pelvic pain on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    129
    112
    124
    Units: Score on a scale
        least squares mean (standard error)
    -4.2 ± 0.16
    -3.9 ± 0.17
    -4.0 ± 0.16
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Not Using Opioids For Endometriosis-associated Pain At Week 104

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    End point title
    Percentage Of Participants Not Using Opioids For Endometriosis-associated Pain At Week 104
    End point description
    Assessed based on usage of study-specified opioids for endometriosis-associated pain recorded daily in an electronic diary. Participants received protocol-specified opioids for treatment of endometriosis-associated pain as needed for pain but not prophylactically.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    277
    247
    275
    Units: Percentage of participants
        number (confidence interval 95%)
    91.0 (87.0 to 94.1)
    88.3 (83.6 to 92.0)
    90.5 (86.5 to 93.7)
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Not Using Analgesics For Endometriosis-associated Pain At Week 104

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    End point title
    Percentage Of Participants Not Using Analgesics For Endometriosis-associated Pain At Week 104
    End point description
    Assessed based on usage of study-specified analgesics for endometriosis-associated pain recorded daily in an electronic diary. Participants received protocol-specified analgesics for treatment of endometriosis-associated pain as needed for pain but not prophylactically.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    277
    247
    275
    Units: Percentage of Participants
        number (confidence interval 95%)
    75.1 (69.6 to 80.1)
    76.5 (70.7 to 81.7)
    76.0 (70.5 to 80.9)
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Who Are "Better" Or "Much Better" On The PGIC For NMPP At Week 52

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    End point title
    Percentage Of Participants Who Are "Better" Or "Much Better" On The PGIC For NMPP At Week 52
    End point description
    The PGIC for NMPP is a 1-item questionnaire designed to assess participant’s impression of change in the severity of pain when they are not menstruating. The questionnaire used a 7-point response scale: much better, better, a little better, the same, a little worse, worse, or much worse.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    221
    202
    230
    Units: Percentage of participants
        number (confidence interval 95%)
    85.5 (80.18 to 89.88)
    86.1 (80.59 to 90.59)
    79.1 (73.30 to 84.19)
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia NRS Scores At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia NRS Scores At Week 52
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. Participants were to report whether they had vaginal sexual intercourse and rated their level of pelvic pain during intercourse on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    151
    126
    140
    Units: Score on a scale
        least squares mean (standard error)
    -3.3 ± 0.18
    -3.0 ± 0.19
    -3.0 ± 0.18
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia NRS Scores At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia NRS Scores At Week 104
    End point description
    Assessed using an NRS score (11-point scale) for pain recorded daily in an electronic diary. Participants were to report whether they had vaginal sexual intercourse and rated their level of pelvic pain during intercourse on a scale from 0 to 10, with 0 indicating no pain and 10 indicating pain as bad as you can imagine. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    79
    61
    69
    Units: Score on a scale
        least squares mean (standard error)
    -3.5 ± 0.21
    -2.9 ± 0.22
    -3.4 ± 0.21
    No statistical analyses for this end point

    Secondary: Percentage Of Participants Who Are "Better" Or "Much Better" On The PGIC For Dyspareunia At Week 52

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    End point title
    Percentage Of Participants Who Are "Better" Or "Much Better" On The PGIC For Dyspareunia At Week 52
    End point description
    The PGIC for dyspareunia is a 1-item questionnaire designed to assess participant’s impression of change in the severity of their pain during sexual intercourse. The questionnaire used a 7-point response scale: much better, better, a little better, the same, a little worse, worse, or much worse.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    210
    194
    210
    Units: Percentage of participants
        number (confidence interval 95%)
    61.0 (54.00 to 67.59)
    61.9 (54.62 to 68.72)
    60.0 (53.03 to 66.68)
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia Functional Impairment At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia Functional Impairment At Week 52
    End point description
    Assessed using the participant-modified Biberoglu and Behrman 5-point scale for dyspareunia recorded daily in an electronic diary. Participants were to report their pain during intercourse daily using the following response options: Severe (avoids intercourse because of pain), Moderate (intercourse painful to the point of causing interruption), Mild (tolerated pain), No pain (no pain during intercourse), or No intercourse (no intercourse for other reasons). Participants gave a possible score of 0 (no pain) to 3 (severe). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    174
    143
    160
    Units: Score on a scale
        least squares mean (standard error)
    -0.9 ± 0.06
    -0.9 ± 0.06
    -0.8 ± 0.06
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia Functional Impairment At Week 104

    Close Top of page
    End point title
    Change From The Pivotal Phase 3 Study Baseline In The Mean Dyspareunia Functional Impairment At Week 104
    End point description
    Assessed using the participant-modified Biberoglu and Behrman 5-point scale for dyspareunia recorded daily in an electronic diary. Participants were to report their pain during intercourse daily using the following response options: Severe (avoids intercourse because of pain), Moderate (intercourse painful to the point of causing interruption), Mild (tolerated pain), No pain (no pain during intercourse), or No intercourse (no intercourse for other reasons). Participants gave a possible score of 0 (no pain) to 3 (severe). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    90
    68
    73
    Units: Score on a scale
        least squares mean (standard error)
    -1.0 ± 0.06
    -0.9 ± 0.07
    -1.0 ± 0.07
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Severity Scores On The Patient Global Assessment (PGA) For Overall Pelvic Pain At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Severity Scores On The Patient Global Assessment (PGA) For Overall Pelvic Pain At Week 52
    End point description
    The PGA for pelvic pain severity is a 1-item questionnaire designed to assess participant’s impression of the severity of their pain. The questionnaire used a 5-point response scale; each response was given a numerical score: absent (0), mild (1), moderate (2), severe (3), or very severe (4). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    232
    206
    226
    Units: Score on a scale
        least squares mean (standard error)
    -1.3 ± 0.06
    -1.2 ± 0.06
    -1.2 ± 0.06
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Severity Scores On The Patient Global Assessment (PGA) For Overall Pelvic Pain At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Severity Scores On The Patient Global Assessment (PGA) For Overall Pelvic Pain At Week 104
    End point description
    The PGA for pelvic pain severity is a 1-item questionnaire designed to assess participant’s impression of the severity of their pain. The questionnaire used a 5-point response scale; each response was given a numerical score: absent (0), mild (1), moderate (2), severe (3), or very severe (4). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    159
    146
    168
    Units: Score on a scale
        least squares mean (standard error)
    -1.4 ± 0.07
    -1.4 ± 0.07
    -1.3 ± 0.07
    No statistical analyses for this end point

    Secondary: Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Overall Pelvic Pain At Week 52

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    End point title
    Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Overall Pelvic Pain At Week 52
    End point description
    The PGA for pelvic pain severity is a 1-item questionnaire designed to assess participant's impression of the severity of their pain. The questionnaire used a 5-point response scale; each response was given a numerical score: absent (0), mild (1), moderate (2), severe (3), or very severe (4).
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    232
    206
    226
    Units: Percentage of Participants
    number (not applicable)
        Improvement (-1 to -4)
    81.5
    69.9
    72.6
        No Change (0)
    14.7
    26.2
    23.0
        Deterioration (+1 to +4)
    3.9
    3.9
    4.4
    No statistical analyses for this end point

    Secondary: Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Overall Pelvic Pain At Week 104

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    End point title
    Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Overall Pelvic Pain At Week 104
    End point description
    The PGA for pelvic pain severity is a 1-item questionnaire designed to assess participant's impression of the severity of their pain. The questionnaire used a 5-point response scale; each response was given a numerical score: absent (0), mild (1), moderate (2), severe (3), or very severe (4).
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    159
    146
    168
    Units: Percentage of participants
    number (not applicable)
        Improvement (-1 to -4)
    85.5
    82.2
    80.4
        No Change (0)
    13.8
    15.8
    16.7
        Deterioration (+1 to +4)
    0.6
    2.1
    3.0
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Function Impairment On The PGA For Function At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Function Impairment On The PGA For Function At Week 52
    End point description
    The PGA for functional impairment is a 1-item questionnaire designed to assess participant’s impression of how their pain affected their usual activities. The participants responded to the question: “How much were your daily activities limited by endometriosis over the last 4 weeks?” using a 5-point response scale; each response was given a numerical score: not at all (0), minimally (1), moderately (2), significantly (3), or very significantly (4). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    206
    230
    Units: Score on a scale
        least squares mean (standard error)
    -1.6 ± 0.06
    -1.6 ± 0.06
    -1.6 ± 0.06
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Function Impairment On The PGA For Function At Week 104

    Close Top of page
    End point title
    Change From The Pivotal Phase 3 Study Baseline In Function Impairment On The PGA For Function At Week 104
    End point description
    The PGA for functional impairment is a 1-item questionnaire designed to assess participant’s impression of how their pain affected their usual activities. The participants responded to the question: “How much were your daily activities limited by endometriosis over the last 4 weeks?” using a 5-point response scale; each response was given a numerical score: not at all (0), minimally (1), moderately (2), significantly (3), or very significantly (4). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    164
    150
    170
    Units: Score on a scale
        least squares mean (standard error)
    -1.9 ± 0.07
    -1.9 ± 0.07
    -1.8 ± 0.07
    No statistical analyses for this end point

    Secondary: Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Function At Week 52

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    End point title
    Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Function At Week 52
    End point description
    The PGA for functional impairment is a 1-item questionnaire designed to assess participant's impression of how their pain affected their usual activities. The participants responded to the question: "How much were your daily activities limited by endometriosis over the last 4 weeks?" using a 5-point response scale; each response was given a numerical score: not at all (0), minimally (1), moderately (2), significantly (3), or very significantly (4).
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    206
    230
    Units: Percentage of participants
    number (not applicable)
        Improvement (-1 to -4)
    88.9
    86.9
    86.1
        No Change (0)
    8.1
    12.6
    10.0
        Deterioration (+1 to +4)
    3.0
    0.5
    3.9
    No statistical analyses for this end point

    Secondary: Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Function At Week 104

    Close Top of page
    End point title
    Percentage Of Participants With Improvement, No Change, Or Worsening From Baseline In PGA Score For Function At Week 104
    End point description
    The PGA for functional impairment is a 1-item questionnaire designed to assess participant's impression of how their pain affected their usual activities. The participants responded to the question: "How much were your daily activities limited by endometriosis over the last 4 weeks?" using a 5-point response scale; each response was given a numerical score: not at all (0), minimally (1), moderately (2), significantly (3), or very significantly (4).
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    164
    150
    170
    Units: Percentage of participants
    number (not applicable)
        Improvement (-1 to -4)
    92.7
    92.0
    91.2
        No Change (0)
    6.7
    7.3
    8.8
        Deterioration (+1 to +4)
    0.6
    0.7
    0
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Each Of The Non-Pain EHP-30 Domains At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Each Of The Non-Pain EHP-30 Domains At Week 52
    End point description
    Assessed using the following non-pain domains of the EHP-30 questionnaire: Control and Powerlessness (questions 12 through 17), Emotional Well-Being (questions 18 through 23), Social Support (questions 24 through 27), and Self-Image (questions 28 through 30). The score for each domain ranged from 0 to 100. Higher scores represent a greater impact of endometriosis. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    232
    207
    229
    Units: Score on a Scale
    least squares mean (standard error)
        Control and Powerlessness
    -43.7 ± 1.61
    -40.1 ± 1.66
    -39.5 ± 1.59
        Emotional Well-being
    -26.7 ± 1.51
    -24.4 ± 1.56
    -23.7 ± 7.49
        Social Support
    -28.8 ± 1.69
    -28.9 ± 1.74
    -28.7 ± 1.67
        Self Image
    -26.4 ± 1.70
    -23.1 ± 1.75
    -22.8 ± 1.68
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Each Of The Non-Pain EHP-30 Domains At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Each Of The Non-Pain EHP-30 Domains At Week 104
    End point description
    Assessed using the following non-pain domains of the EHP-30 questionnaire: Control and Powerlessness (questions 12 through 17), Emotional Well-Being (questions 18 through 23), Social Support (questions 24 through 27), and Self-Image (questions 28 through 30). The score for each domain ranged from 0 to 100. Higher scores represent a greater impact of endometriosis. The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    167
    151
    173
    Units: Score on a scale
    least squares mean (standard error)
        Control and Powerlessness
    -47.5 ± 1.59
    -43.7 ± 1.63
    -41.9 ± 1.54
        Emotional Well-being
    -30.7 ± 1.60
    -26.5 ± 1.65
    -25.6 ± 1.56
        Social Support
    -33.2 ± 1.85
    -24.9 ± 1.90
    -29.7 ± 1.80
        Self Image
    -29.5 ± 1.88
    -25.8 ± 1.94
    -25.2 ± 1.83
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Dysmenorrhea Functional Impairment Score At Week 52

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Dysmenorrhea Functional Impairment Score At Week 52
    End point description
    Assessed using the participant-modified Biberoglu and Behrman 5-point scale for dysmenorrhea recorded daily in an electronic diary. Participants were to report their pain as related to functional impairment daily in an electronic diary using the following response options: Severe (in bed all day, incapacitation), Moderate (in bed part of the day, some loss of work efficiency), Mild (some loss of work efficiency), No pain (no pain associated with menstruation during past 24 hours), or did not menstruate during the past 24 hours. Participants gave a possible score of 0 (no pain) to 4 (did not menstruate). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    204
    233
    Units: Score on a Scale
        least squares mean (standard error)
    -1.3 ± 0.04
    -1.3 ± 0.04
    -1.2 ± 0.04
    No statistical analyses for this end point

    Secondary: Change From The Pivotal Phase 3 Study Baseline In Dysmenorrhea Functional Impairment Score At Week 104

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    End point title
    Change From The Pivotal Phase 3 Study Baseline In Dysmenorrhea Functional Impairment Score At Week 104
    End point description
    Assessed using the participant-modified Biberoglu and Behrman 5-point scale for dysmenorrhea recorded daily in an electronic diary. Participants were to report their pain as related to functional impairment daily in an electronic diary using the following response options: Severe (in bed all day, incapacitation), Moderate (in bed part of the day, some loss of work efficiency), Mild (some loss of work efficiency), No pain (no pain associated with menstruation during past 24 hours), or did not menstruate during the past 24 hours. Participants gave a possible score of 0 (no pain) to 4 (did not menstruate). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    129
    112
    124
    Units: Score on a scale
        least squares mean (standard error)
    -1.3 ± 0.04
    -1.3 ± 0.05
    -1.2 ± 0.04
    No statistical analyses for this end point

    Secondary: Change From Pivotal Phase 3 Study Baseline In NMPP Functional Impairment Score At Week 52

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    End point title
    Change From Pivotal Phase 3 Study Baseline In NMPP Functional Impairment Score At Week 52
    End point description
    Assessed using the participant-modified Biberoglu and Behrman 4-point scale for pelvic pain recorded daily in an electronic diary. Participants reported their pain daily in an electronic diary using the following response options: Severe (requires strong analgesics), Moderate (noticeable pelvic pain), Mild (occasional pelvic pain), or No pain (no pain during past 24 hours). Participants gave a possible score of 0 (no pain) to 3 (severe). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    235
    204
    233
    Units: Score on a scale
        least squares mean (standard error)
    -1.0 ± 0.04
    -1.0 ± 0.05
    -1.0 ± 0.04
    No statistical analyses for this end point

    Secondary: Change From Pivotal Phase 3 Study Baseline In NMPP Functional Impairment Score At Week 104

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    End point title
    Change From Pivotal Phase 3 Study Baseline In NMPP Functional Impairment Score At Week 104
    End point description
    Assessed using the participant-modified Biberoglu and Behrman 4-point scale for pelvic pain recorded daily in an electronic diary. Participants reported their pain daily in an electronic diary using the following response options: Severe (requires strong analgesics), Moderate (noticeable pelvic pain), Mild (occasional pelvic pain), or No pain (no pain during past 24 hours). Participants gave a possible score of 0 (no pain) to 3 (severe). The LS mean was presented by pivotal study treatment group and by visit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    129
    112
    124
    Units: Score on a scale
        least squares mean (standard error)
    -1.2 ± 0.05
    -1.1 ± 0.05
    -1.1 ± 0.05
    No statistical analyses for this end point

    Secondary: Percent Change From The Pivotal Phase 3 Study Baseline In BMD At Lumbar Spine (L1-L4), Femoral Neck, And Total Hip At Week 52

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    End point title
    Percent Change From The Pivotal Phase 3 Study Baseline In BMD At Lumbar Spine (L1-L4), Femoral Neck, And Total Hip At Week 52
    End point description
    Assessed by dual-energy X-ray absorptiometry (DXA) scan at lumbar spine, total hip, and femoral neck (same leg for each participant) at each designated time point. All participants who completed treatment or terminated from the study early were required to return for a 6-month post-treatment follow-up (PTFU) and a 12-month PTFU DXA scan (except if participant was beyond 14 months from last day on treatment). Participants were also to have clinical laboratory evaluations (vitamin D, thyroid stimulating hormone, parathyroid hormone, creatinine, calcium, and phosphorous) at the 6-month and 12-month PTFU only if the PTFU DXA scans showed a bone loss of ≥3% at the lumbar spine and/or total hip compared with the parent study baseline.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    233
    205 [5]
    232 [6]
    Units: Percent change measure
    least squares mean (standard error)
        Lumbar Spine (L1-L4)
    -0.69 ± 0.241
    -1.09 ± 0.256
    -0.09 ± 0.244
        Femoral Neck
    -0.21 ± 0.277
    -0.084 ± 0.294
    0.06 ± 0.280
        Total Hip
    -0.10 ± 0.207
    -0.52 ± 0.219
    0.27 ± 0.210
    Notes
    [5] - Note that the number of participants analyzed for Lumbar Spine was n=204.
    [6] - Note that the number of participants analyzed for Femoral Neck was n=231 and for Total hip was n=231
    No statistical analyses for this end point

    Secondary: Percent Change From The Pivotal Phase 3 Study Baseline In BMD At Lumbar Spine (L1-L4), Femoral Neck, And Total Hip At Week 104

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    End point title
    Percent Change From The Pivotal Phase 3 Study Baseline In BMD At Lumbar Spine (L1-L4), Femoral Neck, And Total Hip At Week 104
    End point description
    Assessed by dual-energy X-ray absorptiometry (DXA) scan at lumbar spine, total hip, and femoral neck (same leg for each participant) at each designated time point. All participants who completed treatment or terminated from the study early were required to return for a 6-month post-treatment follow-up (PTFU) and a 12-month PTFU DXA scan (except if participant was beyond 14 months from last day on treatment). Participants were also to have clinical laboratory evaluations (vitamin D, thyroid stimulating hormone, parathyroid hormone, creatinine, calcium, and phosphorous) at the 6-month and 12-month PTFU only if the PTFU DXA scans showed a bone loss of ≥3% at the lumbar spine and/or total hip compared with the parent study baseline.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    163
    150
    173 [7]
    Units: Percent change measure
    least squares mean (standard error)
        Lumbar Spine (L1-L4)
    -0.45 ± 0.295
    -0.56 ± 0.310
    -0.09 ± 0.292
        Femoral Neck
    0.24 ± 0.325
    -0.44 ± 0.341
    -0.05 ± 0.324
        Total Hip
    0.82 ± 0.268
    0.10 ± 0.281
    0.69 ± 0.267
    Notes
    [7] - Note that the number of participants analyzed for Femoral Neck was and for Total hip was n=170
    No statistical analyses for this end point

    Secondary: Change From Pivotal Phase 3 Study Baseline In Predose Serum Concentrations Of Estradiol At Week 52

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    End point title
    Change From Pivotal Phase 3 Study Baseline In Predose Serum Concentrations Of Estradiol At Week 52
    End point description
    Blood samples were collected from participants for estradiol measurements at each specified timepoints. Estradiol concentrations were measured using an immuno-enzymatic assay based on a commercially available kit.
    End point type
    Secondary
    End point timeframe
    Week 52
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    210
    185
    201
    Units: pg/mL
        arithmetic mean (standard deviation)
    -55.22 ± 99.636
    -77.76 ± 125.791
    -62.07 ± 90.031
    No statistical analyses for this end point

    Secondary: Change From Pivotal Phase 3 Study Baseline In Predose Serum Concentrations Of Estradiol At Week 104

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    End point title
    Change From Pivotal Phase 3 Study Baseline In Predose Serum Concentrations Of Estradiol At Week 104
    End point description
    Blood samples were collected from participants for estradiol measurements at each specified timepoints. Estradiol concentrations were measured using an immuno-enzymatic assay based on a commercially available kit.
    End point type
    Secondary
    End point timeframe
    Week 104
    End point values
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Number of subjects analysed
    148
    133
    157
    Units: pg/mL
        arithmetic mean (standard deviation)
    -51.72 ± 106.801
    -74.68 ± 138.840
    -64.39 ± 104.463
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Week 24/Baseline up to Week 104
    Adverse event reporting additional description
    Extension Safety Population: all enrolled participants who received any amount of open-label study drug in MVT-601-3103. Study results are reported by pivotal study treatment, but all participants only received relugolix Plus E2/NETA.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22.0
    Reporting groups
    Reporting group title
    Relugolix Plus E2/NETA (Group A)
    Reporting group description
    Relugolix 40 mg once daily co-administered with E2 (1 mg) and NETA (0.5 mg) for 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group title
    Relugolix Plus Delayed E2/NETA (Group B)
    Reporting group description
    Relugolix 40 mg monotherapy (once daily) for 12 weeks, followed by oral relugolix 40 mg once daily coadministered with E2 (1mg) and NETA (0.5 mg) for 12 weeks in the pivotal study and Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Reporting group title
    Placebo (Group C)
    Reporting group description
    Relugolix placebo co-administered with E2/NETA placebo for up to 24 weeks in the pivotal study followed by Relugolix 40 mg once daily co-administered with E2/NETA for 80 weeks in this extension study.

    Serious adverse events
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    7 / 277 (2.53%)
    19 / 247 (7.69%)
    18 / 275 (6.55%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Diffuse large B-cell lymphoma
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatic adenoma
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ovarian adenoma
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Papillary thyroid cancer
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Thyroid adenoma
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine leiomyoma
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Abortion missed
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abortion spontaneous
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Anaphylactic reaction
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Broad ligament tear
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endometrial hyperplasia
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endometriosis
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    2 / 275 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metrorrhagia
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ovarian cyst
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pelvic pain
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pulmonary embolism
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Anxiety disorder
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Borderline personality disorder
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Depression
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Drug dependence
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Panic disorder
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Persistent depressive disorder
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Personality disorder
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Suicidal ideation
         subjects affected / exposed
    0 / 277 (0.00%)
    3 / 247 (1.21%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 3
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Suicide attempt
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Suicide threat
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fibula fracture
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tibia fracture
         subjects affected / exposed
    0 / 277 (0.00%)
    2 / 247 (0.81%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Generalised tonic-clonic seizure
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Eye pain
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vision blurred
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain lower
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    0 / 277 (0.00%)
    1 / 247 (0.40%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    0 / 277 (0.00%)
    2 / 247 (0.81%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Urticaria
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endocrine disorders
    Goitre
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    2 / 275 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Appendicitis
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Corona virus infection
         subjects affected / exposed
    0 / 277 (0.00%)
    2 / 247 (0.81%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Laryngitis
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sinusitis
         subjects affected / exposed
    1 / 277 (0.36%)
    0 / 247 (0.00%)
    0 / 275 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vestibular neuronitis
         subjects affected / exposed
    0 / 277 (0.00%)
    0 / 247 (0.00%)
    1 / 275 (0.36%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Relugolix Plus E2/NETA (Group A) Relugolix Plus Delayed E2/NETA (Group B) Placebo (Group C)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    173 / 277 (62.45%)
    106 / 247 (42.91%)
    151 / 275 (54.91%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    38 / 277 (13.72%)
    18 / 247 (7.29%)
    38 / 275 (13.82%)
         occurrences all number
    38
    18
    38
    Reproductive system and breast disorders
    Vulvovaginal dryness
         subjects affected / exposed
    15 / 277 (5.42%)
    7 / 247 (2.83%)
    9 / 275 (3.27%)
         occurrences all number
    15
    7
    9
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    15 / 277 (5.42%)
    7 / 247 (2.83%)
    15 / 275 (5.45%)
         occurrences all number
    15
    7
    15
    Infections and infestations
    Corona virus infection
         subjects affected / exposed
    13 / 277 (4.69%)
    18 / 247 (7.29%)
    21 / 275 (7.64%)
         occurrences all number
    13
    18
    21
    Nasopharyngitis
         subjects affected / exposed
    24 / 277 (8.66%)
    14 / 247 (5.67%)
    22 / 275 (8.00%)
         occurrences all number
    24
    14
    22
    Urinary tract infection
         subjects affected / exposed
    18 / 277 (6.50%)
    12 / 247 (4.86%)
    14 / 275 (5.09%)
         occurrences all number
    18
    12
    14
    Vaginal infection
         subjects affected / exposed
    22 / 277 (7.94%)
    18 / 247 (7.29%)
    17 / 275 (6.18%)
         occurrences all number
    22
    18
    17
    Vulvovaginal mycotic infection
         subjects affected / exposed
    28 / 277 (10.11%)
    12 / 247 (4.86%)
    15 / 275 (5.45%)
         occurrences all number
    28
    12
    15

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Mar 2018
    Amendment 1: to align the protocol with changes made to the parent protocols MVT-601-3101/3102. - Secondary endpoint responder analyses for EHP-30 pain domain added at Week 52. - For endpoint of proportion of responders at Week 52/EOT based on EHP-30 Pain Domain scores, a responder is defined using the same within-patient score change threshold determined from the parent studies. - Updated exclusion criteria 1 to simplify wording to improve clarity. - Clarified that “throughout the study” also included the 30 days following the last dose of study drug. - Clarified that early termination visit DXA is not required if the early termination visit occurred prior to the Week 32 visit or within 4 weeks after completion of the Week 36 DXA. - Procedural details for IVRS/IWRS and e-Diary deactivation added. - Referred reader to study drug labeling for details of study drug storage to ensure most current storage information is used. - New section (“Rescue Analgesic Medications”) added to provide further procedural information and to allow short-term non-study specified analgesics for intercurrent events, if needed. - Clarified the visits at which unused drug kits should be returned to sites. - Clarified procedure to be followed for patients who terminated early but did not undergo an ET visit. - Changed safety vendor. - “ITT” was updated to “modified ITT” to better reflect that planned analysis. - Lot numbers to be maintained during drug accountability to reflect the fact that study drug kits contain lot numbers. - Clarified that safety reporting and protocol modifications will be in accordance with US and non-US health authority requirements. - Updated to specify Tier 1 and Tier 2 study-specified analgesic examples and prescribing procedures.
    11 Dec 2018
    Amendment 2: Extended study to 104 weeks of treatment, inclusive of the 24 weeks in parent study. - Updated primary and secondary objectives to reflect study extension and plan to conduct analyses on data through Week 52 and 104, resulting in a CSR for each analysis. - Included endometrial biopsy at Week 52 and optional endometrial biopsy at Week 104. - Clarified open-label nature of study. - Updated timing elements to reflect extension to 104 total weeks of treatment. - Clarified that first dose of study drug could be initiated up to 10 days after completion of parent study. - Clarified when DXA scans would be conducted and follow-up rules for DXA results. - Clarified visual acuity criteria. - Updated Statistical Methods to reflect extension of treatment and provide a description of analyses to be conducted on Week 104 data. - Updated Schedule of Activities to reflect extension of treatment. - Add telephone contact at Weeks 57, 71, 85,and 98. - Clarified what would be reviewed during telephone contact. - Clarified which physical examinations would include a breast examination. - Clarified timing of eDiary entries. - Reference documents (Lab and Study Reference Manuals) updated to Investigator Site File. - Clarified pregnancy test procedures for patients whose parent study Week 24 visit was different than baseline visit for this study. - Updated pregnancy testing language so that testing would coincide with patient visits from Week 52 to Week 104. - Clarified cannabinoids are prohibited during study. - Clarified where concomitant medications should be recorded. - Indicated that last scheduled ECG is planned for Week 52 visit. - Added language regarding assessment of bone densitometry and follow-up procedures. - Clarified safety assessments that could be performed at unscheduled visits. - Removed PK plasma samples included in error. - Clarified timepoints to be used in efficacy analyses. - Clarified which baseline visit is referenced in text.
    01 Jul 2020
    Amendment 3: included a mammogram at Week 52 or Week 104/Early Termination for women ≥ 40 years old. - Included additional objectives and endpoints to evaluate pelvic pain and analgesic use. - Added mammogram for patients over 40 years age. - Clarified timing of mammograms. - Added details to correspond with the addition of mammograms. - Clarified follow-up procedures for bone mineral density loss. - Clarified procedures for when a patient is lost to follow-up. - Added ECG at Week 104/Early Termination visit. - Added bone densitometry follow-up. - Added clinical laboratory tests during follow-up period since they may be included as part of bone densitometry follow-up. - Added endometrial biopsy follow up. - Added clarifying footnote to Schedule of Activities for status of menstruation recovery during safety follow-up. - Clarified endometrial biopsy procedures and timing. - Included removal criteria for findings resulting from mammogram. - Added language for increased counselling on contraception. - Included COVID-19 guidance. - Removed copper from IUD description to reduce confusion with inclusion criterion 6c. - Clarified investigator role in communicating to sponsor when a patient refuses the endometrial biopsy. - Clarified reporting instructions for adverse events. - Clarified timing of overdose reporting requirements. - Added clarification about the documentation of pregnancy. - Included added assessments of mammograms for patients over 40 and endometrial biopsy to list of safety assessments.
    25 Aug 2020
    Amendment 3.1: included a mammogram at Week 52 or Week 104/Early Termination (ET) for women ≥ 40 years old and revised threshold for post-treatment follow-up. - Included additional objectives and endpoints to evaluate pelvic pain and analgesic use. - Added mammogram for patients ≥ 40 years age details to correspond with this addition. - Clarified timing of mammograms. - Clarified follow-up procedures for bone mineral density (BMD) loss. Lowered threshold for post-treatment follow-up. Specified follow up procedure for BMD loss at Week 104 visit. - Clarified procedures for when a patient is lost to follow-up. - Corrected “modified ITT” population to “Extension Study” population. - Added ECG at Week 104/ET visit. - Added bone densitometry follow-up. - Added clinical laboratory tests during follow-up period since they may be included as part of bone densitometry follow-up. - Added endometrial biopsy follow up. - Added clarifying footnote to Schedule of Activities for status of menstruation recovery during safety follow-up. - Clarified endometrial biopsy procedures and timing. Added an endometrial biopsy at ET visit. - Included removal criteria for findings resulting from mammogram. - Added language for increased counselling on contraception. - Included COVID-19 guidance. - Removed copper from IUD description to reduce confusion with inclusion criterion 6c. - Clarified procedure for laboratory assessment during study and post database lock. - Clarified investigator role in communicating to sponsor when a patient refuses the endometrial biopsy. - Clarified reporting instructions for adverse events. - Clarified timing of overdose reporting requirements. - Added clarification about the documentation of pregnancy. - Included added assessments of mammograms for patients ≥ 40 and endometrial biopsy to list of safety assessments. - Added guidance on site closure and pending follow up procedures - Clarified analysis populations for efficacy/safety data.
    01 Jul 2021
    Amendment 4: added 6-month and 12-month post-treatment follow-up dual-energy x-ray absorptiometry (DXA) scans for all patients. - added 6-month and 12-month post-treatment follow-up DXA scans - Added 6-month and 12-month post-treatment follow-up assessments and labs. - Extended eDiary entry collection to 30-day follow-up visit. - Added new safety objective. - Added new section for collection of fracture events based on recent FDA recommendations. - Clarified patients should only take study-specified analgesics approved in their country. - Defined fragility fracture and request for them to be reported in the posttreatment period.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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