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    Summary
    EudraCT Number:2019-001289-14
    Sponsor's Protocol Code Number:MIT-Do001-C301
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-01-26
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2019-001289-14
    A.3Full title of the trial
    A Randomized Double-blind Placebo Controlled Phase 3 Trial to evaluate the Efficacy and Safety of Estetrol for the Treatment of Moderate to Severe Vasomotor Symptoms in Postmenopausal Women (E4Comfort Study I)
    Studio randomizzato, in doppio cieco, controllato con placebo, di Fase 3 per valutare l’efficacia e la sicurezza di estetrolo per il trattamento dei sintomi vasomotori da moderati a gravi in donne in post-menopausa (Studio I E4Comfort)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Estetrol for the Treatment of Moderate to Severe Vasomotor Symptoms in Postmenopausal Women
    Estetrolo per il trattamento dei sintomi vasomotori da moderati a gravi nelle donne in postmenopausa
    A.3.2Name or abbreviated title of the trial where available
    E4Comfort Study I
    Studio I E4Comfort
    A.4.1Sponsor's protocol code numberMIT-Do001-C301
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorEstetra SPRL
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportEstetra SPRL
    B.4.2CountryBelgium
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEstetra SPRL
    B.5.2Functional name of contact pointDirettore medico
    B.5.3 Address:
    B.5.3.1Street AddressRue de l'Expansion 57
    B.5.3.2Town/ cityFlèmalle
    B.5.3.3Post code4400
    B.5.3.4CountryBelgium
    B.5.4Telephone number+32043492828
    B.5.5Fax number+32043492821
    B.5.6E-mailabastidas@mithra.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameEstetrolo (E4)
    D.3.2Product code [E4]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNestetrolo monoidrato
    D.3.9.1CAS number 2055649-81-3
    D.3.9.2Current sponsor codeE4
    D.3.9.4EV Substance CodeSUB180513
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameEstetrolo (E4)
    D.3.2Product code [E4]
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNestetrolo monoidrato
    D.3.9.1CAS number 2055649-81-3
    D.3.9.2Current sponsor codeE4
    D.3.9.4EV Substance CodeSUB180513
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Utrogestan
    D.2.1.1.2Name of the Marketing Authorisation holderBESINS HEALTHCARE
    D.2.1.2Country which granted the Marketing AuthorisationBelgium
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameUtrogestan
    D.3.2Product code [NA]
    D.3.4Pharmaceutical form Capsule, soft
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPROGESTERONE
    D.3.9.1CAS number 57-83-0
    D.3.9.2Current sponsor codeP4
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Utrogestan
    D.2.1.1.2Name of the Marketing Authorisation holderBESINS HEALTHCARE
    D.2.1.2Country which granted the Marketing AuthorisationBelgium
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameUtrogestan
    D.3.2Product code [na]
    D.3.4Pharmaceutical form Capsule, soft
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPROGESTERONE
    D.3.9.1CAS number 57-83-0
    D.3.9.2Current sponsor codeP4
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboFilm-coated tablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Moderate to Severe Vasomotor Symptoms (VMS) in Postmenopausal Women
    Sintomi vasomotori (VMS) da moderati a gravi nelle donne in postmenopausa
    E.1.1.1Medical condition in easily understood language
    Hot flashes associated with menopause
    Vampate di calore associate alla menopausa
    E.1.1.2Therapeutic area Diseases [C] - Hormonal diseases [C19]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.0
    E.1.2Level LLT
    E.1.2Classification code 10020407
    E.1.2Term Hot flashes
    E.1.2System Organ Class 100000004866
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Arms 1-3: To measure the effect of treatment with E4 15 mg or E4 20 mg compared to placebo on the frequency and severity of moderate to severe VMS in postmenopausal women at 4 and 12 weeks

    Arm 4: To evaluate the effect of treatment with E4 20 mg / P4 100 mg on the endometrium
    Bracci 1-3: Misurare l'effetto del trattamento con E4 da 15 mg o E4 da 20 mg rispetto al placebo sulla frequenza e la gravità dei VMS da moderati a gravi nelle donne in postmenopausa a 4 e 12 settimane

    Braccio 4: Valutare l'effetto del trattamento con E4 da 20 mg/P4 da 100 mg sull'endometrio
    E.2.2Secondary objectives of the trial
    Arm 1-3: treatment with E4 15 mg or E4 20 mg :
    -To measure the effect of treatment compared to placebo on the frequency and severity of moderate to severe VMS in postmenopausal women weekly up to 12 weeks, on symptoms of VVA, lipid and glucose metabolism, Health-related quality of life (HRQoL) and treatment satisfaction (TS), and on the endometrium and vaginal bleeding in non hysterectomized subjects.
    -To measure the clinical meaningfulness compared to placebo on the reduction of VMS at weeks 4 and 12
    -To evaluate the general safety of treatment compared to placebo

    Arm 4: treatment with E4 20 mg / P4 100 mg
    - To evaluate the general safety of treatment
    - To evaluate the effect of treatment on vaginal bleeding, on HRQoL and TS and on lipid and glucose metabolism.
    Bracci 1-3: Trattamento con E4 15 mg oppure E4 20 mg:
    - Misurare settimanalmente l'effetto del trattamento rispetto al placebo sulla frequenza e gravità dei VMS da moderati a gravi nelle donne in postmenopausa fino a 12 settimane, sui sintomi di atrofia vulvovaginale (VVA), sul metabolismo lipidico e del glucosio, sulla qualità della vita correlata alla salute (HRQoL) e sulla soddisfazione in merito al trattamento (TS) nonché sull'endometrio e il sanguinamento vaginale in soggetti non isterectomizzati
    - Misurare la significatività clinica rispetto al placebo sulla riduzione dei VMS alla settimane 4 e 12
    - Valutare la sicurezza generale del trattamento rispetto al placebo

    Braccio 4: Trattamento con E4 20 mg/P4 100 mg:
    - Valutare la sicurezza generale del trattamento
    - Valutare l'effetto del trattamento sul sanguinamento vaginale, sull'HRQoL, sul TS e sul metabolismo lipidico e del glucosio
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Signed and dated written informed consent form and any required privacy authorization prior to the initiation of any trial procedure, after the nature of the trial has been explained according to local regulatory requirements;
    2. Females, = 40 up to = 65 years of age at randomization/treatment allocation;
    3. For hysterectomized subjects: documented hysterectomy must have occurred at least 6 weeks prior to the start of screening. Hysterectomy can be total or subtotal (i.e., cervix was not removed).
    4. For non-hysterectomized subjects: uterus with bi-layer endometrial thickness = 4 mm on transvaginal ultrasound (TVUS) (Amendment 1, November 28, 2019);
    5. For non-hysterectomized subjects: an evaluable endometrial biopsy taken during screening that reveals no abnormal results, i.e., presence of hyperplasia (simple or complex, with or without atypia), presence of carcinoma, and presence of disordered proliferative findings. The screening biopsy should have sufficient endometrial tissue for diagnosis;
    6. Seeking treatment for relief of VMS associated with menopause;
    a) For the Efficacy Study part: at least 7 moderate to severe bothersome VMS per day or at least 50 moderate to severe bothersome VMS per week in the last 7 consecutive days during the Screening period ;
    b) For the Endometrial and General Safety Study part: at least 1 moderate to severe VMS per week;
    7. Body mass index = 18.0 kg/m² to = 38.0 kg/m²;
    8. A mammogram that shows no sign of significant disease performed during screening or within 9 months prior to the start of screening ;
    9. Post-menopausal status defined as any of the following:
    a) For non-hysterectomized subjects:
    - at least 12 months of spontaneous amenorrhea with serum follicle stimulating hormone (FSH) >40 mIU/ml (value obtained after washout of estrogen/progestin containing drugs, see exclusion criteria 18 and 20);
    - or at least 6 months of spontaneous amenorrhea with serum FSH >40 mIU/mL and E2 <20 pg/mL (<73.4 pmol/L, value obtained after washout of estrogen/progestin containing drugs, see exclusion criteria 18 and 20) (Amendment 2, February 24, 2020);
    - or at least 6 weeks postsurgical bilateral oophorectomy3;
    b) For hysterectomized subjects:
    - serum FSH >40 mIU/mL and E2 <20 pg/mL (<73.4 pmol/L, values obtained after washout of estrogen/progestin containing drug see exclusion criteria 18 and 20) (Amendment 2, February 24, 2020);
    - or at least 6 weeks post-surgical bilateral oophorectomy ;
    10. Good physical and mental health, in the judgement of the Investigator as based on medical history, physical and gynecological examination and clinical assessments performed prior to Visit 1;
    11. Able to understand and comply with the protocol requirements, instructions, and protocol-stated restrictions;
    12. Able and willing to complete trial daily paper diaries (if applicable, see Section 10.1.7) and questionnaires.
    1. Soggetti che abbiano firmato e datato il modulo di consenso informato scritto e qualsiasi autorizzazione alla privacy richiesta prima dell'avvio di qualsiasi procedura della sperimentazione, dopo che la natura della sperimentazione è stata loro spiegata secondo le disposizioni normative locali;
    2. Soggetti di sesso femminile con età compresa tra =40 e =65 anni al momento della randomizzazione/assegnazione del trattamento;
    3. Per i soggetti isterectomizzati: l'isterectomia (documentata) deve essere avvenuta almeno o 6 settimane prima dell'inizio dello screening. L'isterectomia può essere totale o parziale (cioè, senza rimozione della cervice).
    4. Per soggetti non isterectomizzati: utero con spessore endometriale bi-strato =4 mm su ecografia transvaginale (TVUS) (Emendamento 1, 28 novembre 2019);
    5. Per i soggetti non isterectomizzati: una biopsia endometriale valutabile eseguita durante lo screening che non riveli risultati anomali, cioè presenza di iperplasia (semplice o complessa, con o senza atipia), presenza di carcinoma e presenza di reperti di disordine proliferativo. La biopsia dello screening dovrebbe avere tessuto endometriale sufficiente per la diagnosi;
    6. In cerca di un trattamento per il sollievo dei VMS associati alla menopausa;
    a) Per la parte dello Studio sull'efficacia: almeno 7 VMS fastidiosi da moderati a gravi al giorno oppure almeno 50 VMS fastidiosi da moderati a gravi a settimana negli ultimi 7 giorni consecutivi durante il periodo di screening;
    b) Per la parte dello Studio sulla sicurezza endometriale e generale: almeno 1 VMS da moderato a grave a settimana;
    7. Indice di massa corporea da =18,0 kg/m² a =38,0 kg/m²;
    8. Un mammogramma da cui non si evinca alcun segno di malattia significativa eseguito durante lo screening o nei 9 mesi prima dell'inizio dello screening;
    9. Per "stato di post-menopausa" s'intende una qualunque delle definizioni seguenti:
    a) Per i soggetti non isterectomizzati:
    - almeno 12 mesi di amenorrea spontanea con ormone follicolo-stimolante (FSH) sierico >40 mIU/mL (valore ottenuto dopo il washout di farmaci contenenti estrogeno/progestinico, consultare i criteri di esclusione 18 e 20);
    - oppure almeno 6 mesi di amenorrea spontanea con FSH sierico >40 mIU/mL ed E2 <20 pg/mL (<73.4 pmol/L, valori ottenuti dopo il washout di farmaci contenenti estrogeno/progestinico, consultare i criteri di esclusione 18 e 20) (Emendamento 2, 24 febbraio 2020);
    - oppure che siano trascorse almeno 6 settimane dall'ooforectomia bilaterale ;
    b) Per i soggetti isterectomizzati:
    - FSH sierico >40 mIU/mL ed E2 <20 pg/mL (<73.4 pmol/L, valori ottenuti dopo il washout di farmaci contenenti estrogeno/progestinico, consultare i criteri di esclusione 18 e 20) (Emendamento 2, 24 febbraio 2020);
    - oppure che siano trascorse almeno 6 settimane dall'ooforectomia bilaterale;
    10. Buona salute fisica e mentale, a giudizio dello sperimentatore, sulla base dell'anamnesi medica, dell'esame obiettivo e ginecologico e delle valutazioni cliniche effettuate prima della Visita 1;
    11. In grado di comprendere e rispettare i requisiti del protocollo, le istruzioni e le restrizioni espresse nel protocollo;
    12. In grado e disposti a completare i diari cartacei giornalieri e i questionari della sperimentazione (se applicabile, consultare la sezione 10.1.7 del Protocollo).
    E.4Principal exclusion criteria
    1. History of malignancy with the exception of basal cell or squamous cell carcinoma of the skin if diagnosed more than 1 year prior to the Screening visit;
    2. Any clinically significant findings found by the Investigator at the breast examination and/or on mammography suspicious of breast malignancy that would require additional clinical testing to rule out breast cancer (however, simple cysts confirmed by ultrasound are allowed);
    3. PAP test with atypical squamous cells undetermined significance (ASC-US) or higher (low-grade squamous intraepithelial lesion [LSIL], atypical squamous cells- cannot exclude high-grade squamous intraepithelial lesion [HSIL] [ASC-H], HSIL dysplastic or malignant cells) in sub-totally hysterectomized and non-hysterectomized subjects . Note: ASC-US is allowed if a reflex human papilloma virus (HPV) testing is performed and is negative for high risk oncogene HPV;
    4. For non-hysterectomized subjects:
    a) History or presence of uterine cancer, endometrial hyperplasia, disordered proliferative findings;
    b) Presence of endometrial polyps;
    c) Undiagnosed vaginal bleeding or undiagnosed abnormal uterine bleeding;
    d) Endometrial ablation;
    e) Any uterine/endometrial abnormality that in the judgment of the investigator contraindicates the use of estrogen and/or progestin therapy. This includes presence or history of adenomyosis or significant myoma (Amendment 2, February 24, 2020);
    5. Systolic blood pressure (BP) higher than 130 mmHg, diastolic BP higher than 80 mmHg during screening;
    6. History of venous or arterial thromboembolic disease (e.g., superficial or deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, angina pectoris, etc.), or first degree family history of VTE;
    7. History of known acquired or congenital coagulopathy or abnormal coagulation factors, including known thrombophilia’s;
    8. Laboratory values of fasting glucose ranges above 125 mg/dL (>6.94 mmol/L) and/or glycated hemoglobin above 7% (Amendment 2, February 24, 2020);
    9. Dyslipoproteinemia (LDL >190 mg/dL [>4.91 mmol/L] and/or triglycerides >300 mg/dL [>3.39 mmol/L]) (Amendment 1, November 28, 2019 and Amendment 2, February 24, 2020);
    10. Subjects smoking >15 cigarettes per day (Amendment 1, November 28, 2019);
    11. Presence or history of gallbladder disease, unless cholecystectomy has been performed;
    12. Systemic lupus erythematosus;
    13. Any malabsorption disorders including gastric bypass surgery;
    14. History of acute liver disease in the preceding 12 months before the start of screening or presence or history of chronic or severe liver disease [alanine transaminase (ALT) or aspartate transaminase (AST) >2x upper limit of normal (ULN), bilirubin >1.5 ULN]; or liver tumors;
    15. Chronic or current acute renal impairment (estimated glomerular filtration rate <60 ml/min);
    16. Porphyria;
    17. Diagnosis or treatment of major psychiatric disorder (e.g., schizophrenia, bipolar disorder, etc.) in the judgement of the investigator;
    Refer to the study protocol for additional exclusion criteria.
    1.Eventi pregressi di tumori maligni ad eccezione del carcinoma a cellule basali o squamose della pelle, se diagnosticato più di 1 anno prima della visita di screening;
    2.Qualsiasi risultato clinicamente significativo riscontrato dallo sperimentatore all'esame del seno e/o sospetto di carcinoma mammario all'esame della mammografia che richiederebbe ulteriori test clinici per escludere il cancro al seno (tuttavia, sono ammesse semplici cisti confermate da ecografia);
    3.PAP test con cellule squamose atipiche di significato indeterminato (ASC-US) o superiore (lesione squamosa intraepiteliale di basso grado (LSIL), cellule squamose atipiche - non si possono escludere lesioni squamose intraepiteliali di alto grado (HSIL)/(ASC-H), HSIL displastiche o cellule maligne) in soggetti totalmente/parzialmente isterectomizzati e non isterectomizzati. Nota: L'ASC-US è consentito se viene eseguito un test HPV reflex (papilloma virus umano) che risulta negativo per l'HPV ad alto rischio oncogeno;
    4.Per i soggetti non isterectomizzati:
    a)Eventi pregressi o presenza di cancro uterino, iperplasia endometriale, reperti di disordine proliferativo;
    b)Presenza di polipi endometriali;
    c)Sanguinamento vaginale non diagnosticato o sanguinamento uterino atipico non diagnosticato;
    d)Ablazione endometriale;
    e)Qualsiasi anomalia uterina/endometriale che secondo il parere dello sperimentatore è una controindicazione per l’uso di terapia estrogenica e/o progestinica. Ciò include la presenza o anamnesi di adenomiosi o mioma significativo (Emendamento 2, 24 febbraio 2020);
    5.Pressione sistolica (BP) superiore a 130 mmHg e pressione diastolica superiore a 80 mmHg durante lo screening;
    6.Eventi pregressi di malattie tromboemboliche venose o arteriose (ad esempio, trombosi venosa superficiale o profonda, embolia polmonare, ictus, infarto del miocardio, angina pectoris, ecc.) o famigliarità di primo grado alla VTE;
    7.Eventi pregressi di coagulopatia acquisita o congenita nota o fattori di coagulazione anomali, compresa trombofilia nota;
    8.Valori di laboratorio degli intervalli di glicemia a digiuno 125 mg/dl (>6,94 mmol/l) e/o emoglobina glicata superiore al 7% (Emendamento 2, 24 febbraio 2020);
    9.Dislipoproteinemia (LDL >190 mg/dl [>4,91 mmol/l] e/o trigliceridi >300 mg/dl [>3,39 mmol/l]) (Emendamento 1, 28 novembre 2019 ed Emendamento 2, 24 febbraio 2020);
    10.Soggetti che fumano >15 sigarette al giorno (Emendamento 1, 28 novembre 2019);
    11.Presenza o eventi pregressi di malattia della cistifellea, a meno che non sia stata eseguita una colecistectomia;
    12.Lupus eritematoso sistemico;
    13.Qualunque disturbo da malassorbimento, compreso intervento chirurgico di bypass gastrico;
    14.Eventi pregressi di malattia epatica acuta nei 12 mesi prima dell'inizio dello screening o presenza o eventi pregressi di malattia epatica cronica o grave (alanina transaminasi (ALT) o aspartato transaminasi (AST) >2 x limite superiore della norma (ULN), bilirubina >1,5 ULN); o tumori epatici;
    15.Insufficienza renale acuta cronica o attuale (velocità di filtrazione glomerulare stimata <60 mL/min);
    16.Porfiria;
    17.Diagnosi o trattamento di disturbi psichiatrici maggiori (es. schizofrenia, disturbo bipolare, ecc.) a giudizio dello sperimentatore;
    Per ulteriori criteri riferirsi al protocollo.
    E.5 End points
    E.5.1Primary end point(s)
    Arms 1-3: 1.1.
    - Mean change in weekly frequency of moderate to severe VMS from baseline to week 4 and week 12
    - Mean change in severity of moderate to severe VMS from baseline to week 4 and week 12

    Arm 4:
    - Change from baseline to each measured time point in endometrial thickness measured by ultrasound
    - Frequency of disordered proliferative endometrium, benign simple hyperplasia or hyperplasia with atypia or higher anomalies after 12 months of treatment based on endometrial biopsies
    Bracci 1-3:
    - Variazione media della frequenza settimanale dei VMS da moderati a gravi dal basale alla settimana 4 e alla settimana 12
    - Variazione media della gravità settimanale dei VMS da moderati a gravi dal basale alla settimana 4 e alla settimana 12
    Braccio 4:
    - Variazione dal basale a ciascun punto temporale misurato dello spessore endometriale misurato tramite ecografia
    - Frequenza dell'endometrio proliferativo disfunzionale, iperplasia benigna semplice o iperplasia con atipia o anomalie superiori dopo 12 mesi di trattamento in base alle biopsie endometriali
    E.5.1.1Timepoint(s) of evaluation of this end point
    Arm 1-3: Week 4 and Week 12
    Arm 4: Day 1, Week 13, 29, 53
    Bracci 1-3: Settimana 4 e settimana 12
    Braccio 4: Giorno 1, settimana 13, 29 e 53
    E.5.2Secondary end point(s)
    Arms 1-3
    For Objective 1:
    -Change from baseline to week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 in the weekly frequency of moderate to severe VMS, and in the severity of moderate to severe VMS
    -Change from baseline to weeks 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 in the weekly frequency and severity of mild, moderate and severe VMS
    -Percentage of subjects with 50% and 75% reduction from baseline in the weekly frequency of moderate to severe VMS at weeks 4 and 12
    For Objective 2:
    -Percentage of subjects with a clinically important difference (CID) compared to baseline in the weekly frequency of moderate to severe VMS at weeks 4 and 12 using the Clinical Global Impression (CGI) questionnaire
    For Objective 3:
    -Change from baseline to week 12 in VVA symptoms (subject self-assessment) using VVA questionnaire
    -Change from baseline to week 12 in the VVA symptom (subject self-assessment) that is initially identified by the subject as being the most bothersome using the VVA questionnaire at baseline
    For Objective 4
    -Change from baseline to week 12 in triglycerides, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, total cholesterol, lipoprotein(a), total cholesterol/HDL-cholesterol ratio, fasting glycemia, insulin, glycated hemoglobin and homeostasis model assessment-estimated insulin resistance (HOMA-IR)
    For Objective 5:
    -Change from baseline to week 12 in HRQoL using the Menopause-specific Quality of Life (MENQOL) questionnaire
    -Total score in TS after 4 and 12 weeks of treatment using the he Clinical
    Global Impression (CGI) questionnaire
    For Objective 6:
    -Frequency of treatment emergent adverse events (TEAEs) (including treatment emergent serious adverse events [SAE] monitoring)
    -Frequency of changes in results in physical and gynecological examination, vital signs, electrocardiogram (ECG) and breast examination at each measured time point
    -Frequency of changes in routine clinical laboratory tests results (hematology and chemistry) at each measured time point
    For Objective 7:
    -Change from baseline to each measured time point in endometrial thickness measured by ultrasound
    -Frequency of subjects in the different endometrial categories according to the Blaustein's pathology (see Protocol Appendix 16.4) in subjects for whom an endometrial biopsy has been taken
    For Objective 8:
    -Frequency of women with vaginal bleeding and/or spotting during each 28-day cycle of treatment with E4 based on recording in the patient diary
    -Frequency of women with amenorrhea (absence of any bleeding or spotting) during each 28-day cycle of treatment with E4 based on recording in the patient diary

    Arm4
    For Objective 1:
    -Frequency of TEAEs (including SAEs)
    -Frequency of changes in results in physical and gynecological examination, vital signs, ECG, mammography, and breast examination at each measured time point
    -Frequency of changes in routine clinical laboratory tests results (hematology and chemistry) at each measured time point
    For Objective 2:
    -Frequency of women with vaginal bleeding and/or spotting during each 28-day cycle of treatment based on recording in the patient diary
    -Frequency of women with amenorrhea (absence of any bleeding or spotting) during each 28-day cycle of treatment based on recording in the patient diary
    For Objective 3 and 4, related to Arm 4, please refer to Study Protocol.
    Bracci 1-3:
    Per l'obiettivo 1
    - Variazione dal basale alla settimana 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 e 12 della frequenza dei VMS da moderati a gravi e della gravità settimanale dei VMS da moderati a gravi
    - Variazione dal basale alla settimana 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 e 12 della frequenza e gravità settimanale dei VMS lievi, moderati e gravi
    - Percentuale di soggetti con il 50% e 75% di riduzione dal basale della frequenza settimanale dei VMS da moderati a gravi alla settimana 4 e 12
    Per l'obiettivo 2- Percentuale di soggetti con una differenza clinicamente importante (CID) rispetto al basale nella frequenza settimanale dei VMS da moderati a gravi alla settimana 4 e 12, utilizzando il questionario sull'Impressione clinica globale (CGI)
    Per l'obiettivo 3
    - Variazione dal basale alla settimana 12 dei sintomi di VVA (autovalutazione da parte del soggetto) utilizzando il questionario sulla VVA
    - Variazione dal basale alla settimana 12 del sintomo di VVA (autovalutazione da parte del soggetto) inizialmente identificato dal soggetto come il più fastidioso utilizzando il questionario sulla VVA al basale
    Per l'obiettivo 4
    Variazione dal basale alla settimana 12 dei valori di trigliceridi, colesterolo associato alle lipoproteine ad alta densità (HDL), colesterolo associato alle lipoproteine a bassa densità (LDL), colesterolo totale, lipoproteina (A), rapporto colesterolo totale/colesterolo HDL, glicemia a digiuno, insulina, emoglobina glicata e indice HOMA-IR (valutazione del modello omeostatico/insulino-resistenza stimata)
    Per l'obiettivo 5
    - Variazione dal basale alla settimana 12 del HRQoL utilizzando il questionario sulla qualità della vita specifico per la menopausa (MENQOL
    - Punteggio totale del TS dopo 4 e 12 settimane di trattamento utilizzando il questionario CGI (Impressione clinica globale)
    Per l'obiettivo 6
    - Frequenza degli eventi avversi emergenti dal trattamento (TEAE) (compreso il monitoraggio degli eventi avversi gravi emergenti dal trattamento (SAE))
    - Frequenza delle variazioni nei risultati dell'esame obiettivo e ginecologico, dei parametri vitali, dell'elettrocardiogramma (ECG) e dell'esame al seno in ogni punto temporale misurato
    - Frequenza delle variazioni nei risultati dei test clinici di routine di laboratorio (ematologici e chimici) in ogni punto temporale misurato
    Per l'obiettivo 7
    - Variazione dal basale a ciascun punto temporale misurato dello spessore endometriale misurato tramite ecografia
    - Frequenza dei soggetti nelle diverse categorie endometriali secondo il Blaustein's Pathology (cfr. appendice 16.4 del Protocollo) per i soggetti per i quali è stata eseguita una biopsia endometriale
    Per l'obiettivo 8
    - Frequenza delle donne con sanguinamento vaginale e/o piccole perdite (spotting) durante ogni ciclo di trattamento con E4 di 28 giorni, in base a quanto registrato sul diario della paziente
    - Frequenza delle donne con amenorrea (assenza di qualunque sanguinamento o perdite) durante ogni ciclo di trattamento con E4 di 28 giorni, in base a quanto registrato sul diario della paziente

    Braccio 4
    Per l'obiettivo 1
    - Frequenza dei TEAE (compresi i SAE)
    - Frequenza delle variazioni nei risultati dell'esame obiettivo e ginecologico, dei parametri vitali, dell'ECG, della mammografia e dell'esame al seno in ogni punto temporale misurato
    - Frequenza delle variazioni nei risultati dei test clinici di routine di laboratorio (ematologici e chimici) in ogni punto temporale misurato
    Per l'obiettivo 2
    - Frequenza delle donne con sanguinamento vaginale e/o piccole perdite (spotting) durante ogni ciclo di trattamento di 28 giorni, in base a quanto registrato sul diario della paziente
    - Frequenza delle donne con amenorrea (assenza di qualunque sanguinamento o perdite) durante ogni ciclo di trattamento di 28 giorni, in base a quanto registrato sul diario della paziente
    Per gli obiettivi 3 e 4 relativi al Braccio 4 si prega di riferirsi al Protocollo di Studio.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Arm 1-3:
    For Objective 1 - up to Week 12
    For Objective 2 - Week 4 and 12
    For Objective 3 - Day 1 and Week 12
    For Objective 4 - Day 1 and Week 12
    For Objective 5 - Day 1 and Week 12; - 4 and 12 Weeks
    For Objective 6 - Day 1, Week 5, 9, 13, 15/16
    For Objective 7 - Day 1, Week 13, Week 15/16; - Week 13
    For Objective 8 - each 28 day cycle

    Arm 4:
    For Objective 1 - Day 1, Week 5, 13, 29, 41 and 53
    For Objective 2 - each 28 day cycle
    For Objective 3 - Day 1, Week 12 and 52; - Week 4, 12 and 52
    For Objective 4 - Day 1, Week 12 and 52
    Bracci 1-3:
    Per l'Obiettivo 1 - fino alla settimana 12
    Per l'Obiettivo 2 - settimana 4 e 12
    Per l'Obiettivo 3 - giorno 1 e settimana 12
    Per l'Obiettivo 4 - giorno 1 e settimana 12
    Per l'Obiettivo 5 - giorno 1 e settimana 12; - settimana 4 e 12
    Per l'Obiettivo 6 - giorno 1, settimana 5, 9, 13, 15/16
    Per l'Obiettivo 7 - giorno 1, settimana 13, settimana 15/16; - settimana 13 Per l'Obiettivo 8 - ogni ciclo di 28 giorni

    Braccio 4:
    Per l'Obiettivo 1 - giorno 1, settimana 5, 13, 29, 41 e 53 Per l'Obiettivo 2 - ogni ciclo di 28 giorni
    Per l'Obiettivo 3 - giorno 1, settimana 12 e 52; - Settimana 4, 12 e 52
    Per l'Obiettivo 4 - giorno 1, settimana 12 e 52
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Lo studio sull'endometrio e sulla sicurezza generale ha un disegno in aperto
    The Endometrial and General Safety Study has an open label design.
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA78
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Brazil
    Russian Federation
    Czechia
    Hungary
    Italy
    Lithuania
    Poland
    Romania
    Slovakia
    Spain
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years0
    E.8.9.1In the Member State concerned months16
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years0
    E.8.9.2In all countries concerned by the trial months16
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 1200
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male No
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state47
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 880
    F.4.2.2In the whole clinical trial 1200
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    NONE
    NESSUNO
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2020-02-04
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-01-14
    P. End of Trial
    P.End of Trial StatusOngoing
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