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Flushing Reduction Associated With Nitrates (FRAN)

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ClinicalTrials.gov Identifier: NCT02714205
Recruitment Status : Recruiting
First Posted : March 21, 2016
Last Update Posted : January 28, 2019
Sponsor:
Collaborator:
National Institute on Aging (NIA)
Information provided by (Responsible Party):
Alison Huang, University of California, San Francisco

Brief Summary:
A randomized, double-blinded, placebo-controlled trial of uninterrupted transdermal nitrate therapy in 140 peri- or postmenopausal women who have frequent hot flashes. Women will be randomly assigned to uninterrupted use of transdermal nitrate therapy (participant directed dose-escalation of 0.2 to 0.6 mg/hr) or identical-appearing placebo patches for 12 weeks.

Condition or disease Intervention/treatment Phase
Menopausal Hot Flashes Drug: transdermal nitroglycerin Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 140 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Flushing Reduction Associated With Nitrates
Actual Study Start Date : April 24, 2017
Estimated Primary Completion Date : March 2020
Estimated Study Completion Date : June 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Transdermal Nitroglycerin
Daily transdermal nitroglycerin patch, starting at 0.2 mg/hr. Dose escalation up to 0.6 mg/hr.
Drug: transdermal nitroglycerin
Study participants will be randomized to transdermal nitroglycerin patch or placebo patch. Participants will wear a study medication patch daily, for 12 weeks.

Placebo Comparator: Placebo
Daily transdermal placebo patch.
Drug: Placebo
Study participants will be randomized to transdermal nitroglycerin patch or placebo patch. Participants will wear a study medication patch daily, for 12 weeks.




Primary Outcome Measures :
  1. Change from baseline hot flash frequency at 12 weeks. [ Time Frame: Baseline and 12 weeks ]

Secondary Outcome Measures :
  1. Change from baseline Hot Flash Related Daily Interference Scale (HFRDIS) score at 12 weeks. [ Time Frame: Baseline and 12 weeks ]
  2. Change from baseline Menopause Quality of Life (MENQOL) score at 12 weeks. [ Time Frame: Baseline and 12 weeks ]
  3. Change from baseline Pittsburgh Sleep Quality Index (PSQI) score at 12 weeks. [ Time Frame: Baseline and 12 weeks ]
  4. Change from baseline Generalized Anxiety Disorder-7 (GAD-7) score at 12 weeks. [ Time Frame: Baseline and 12 weeks ]
  5. Change from baseline Center for Epidemiologic Studies Depression (CES-D) Score at 12 weeks. [ Time Frame: Baseline and 12 weeks ]
  6. Change in baseline frequency of moderate-to-severe hot flashes at 12 weeks. [ Time Frame: Baseline and 12 weeks ]
  7. Change in baseline total hot flash severity score at 12 weeks. [ Time Frame: Baseline and 12 weeks ]

Other Outcome Measures:
  1. Number of participants with treatment related severe adverse events defined by Common Terminology for Adverse Event Criteria (CTAEC) severity grade 3 or higher. [ Time Frame: Baseline and 12 weeks ]


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Ages Eligible for Study:   40 Years to 62 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Women aged 40 to 62 years (consistent with the recent MSFlash hot flash network trials, and likely to maximize enrollment of highly symptomatic women)
  • Postmenopausal or in the late menopausal transition. For this study, postmenopausal status will be defined by: 1) self-reported history of bilateral oophorectomy, 2) follicle stimulating hormone (FSH) levels > 20 mU/mL for those with a self-reported history of hysterectomy without bilateral oophorectomy, or 3) no self-reported history of hysterectomy or oophorectomy, but absence of menses in the past 12 months. Late menopausal transition will be defined by amenorrhea for at least 60 days in the past 12 months within the specified age group.
  • Documentation of an average of 7 or more hot flashes per 24 hours as well as 4 or more moderate-to-severe hot flashes per 24 hours as recorded on a validated 7-day screening symptom diary
  • Willing to refrain from initiating other treatments that are known to affect the frequency of severity hot flashes during the trial period
  • Report having a current primary health care provider (such as a general practitioner, family medicine, internal medicine, or nurse practitioner providing primary care or specializing in women's health)

Exclusion Criteria:

  • Current or recent use of NTG or other nitrate-containing medications (i.e., use within 1 month of screening), or intention to use nitrate-containing medication during the interventional period
  • Current or recent use of medications already known to reduce the frequency or severity of hot flashes (e.g., vaginal or transdermal estrogens in the past 4 weeks; oral estrogens or progestins in the past 8 weeks; intrauterine progestin therapy in the past 8 weeks; progestin implants or estrogen alone injectable therapy in the past 3 months; estrogen pellet therapy or progestin injectable therapy in the past 6 months; clonidine, methyldopa, gabapentin, pregabalin and selective serotonin or norepinephrine reuptake inhibitors (SSRIs/SNRIs) in the past 1 month); or intention to use these medications during the interventional period
  • Current or recent use of phosphodiesterase inhibitor medications (within 1 month of screening), or intention to use these medications during the interventional period
  • Current or recent use of riociguat, a soluble guanylate cyclase stimulator medication, within 1 month of screening, or intention to use riociguat during the interventional period
  • Self-reported history of hypertrophic obstructive cardiomyopathy, aortic valve stenosis, or mitral valve stenosis (since symptoms of these conditions may be aggravated by NTG therapy)
  • Self-reported history of coronary disease (since patients with coronary disease may need NTG therapy for chest pain or may be at increased risk of new coronary events in the setting of nitrate tolerance), or evidence of prior myocardial infarction on screening electrocardiogram (ECG)
  • Self-reported history of diabetes or 2 or more major risk factors for coronary disease (i.e., smoking, hypertension, or hyperlipidemia with physician-recommended pharmacologic treatment)
  • Evidence of tachyarrhythmias such as atrial fibrillation or flutter without adequate rate control (>110 beats/minute) on screening ECG
  • Evidence of second or third-degree atrioventricular block on screening ECG
  • Hypotension based on measured resting blood pressure <90/60 at baseline; or normal resting blood pressure but evidence of orthostatic hypotension with change from supine to standing position)
  • Uncontrolled hypertension based on measured resting blood pressure > 180/110 at baseline
  • Self-reported headaches interfering with activities of daily activities more than twice a month, or use of prescription medication to prevent or treat headache in the past month (since these may be worsened by NTG therapy)
  • Known allergy to nitroglycerin or other nitrate-based medications.
  • Known skin sensitivity to adhesives (which may generalize to the NTG patches)
  • Unable to complete or tolerate a brief 3-day run-in period involving the lowest available dose of NTG (0.1 mg/hr)
  • Currently pregnant, gave birth within the past 3 months, planning pregnancy during the study period, or unwilling to use regular barrier contraception or abstain from sexual activity to prevent pregnancy if not yet postmenopausal
  • Currently breastfeeding, breastfeeding within the past 3 months, or planning to breastfeed during the study period
  • Self-report heavy alcohol use (>3 drinks in a given day or >7 drinks per week) and uncomfortable or unwilling to decrease their alcohol intake during the study period.
  • Unable or unwilling to provide informed consent, fill out questionnaires, or complete study visits in English
  • Report other conditions that, in the judgment of the investigators, render potential participants highly unlikely to follow the protocol, including plans to move, substance abuse, significant psychiatric problems, or severe dementia.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02714205


Contacts
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Contact: Traci Plaut 415-885-7547 Traci.Plaut@ucsf.edu
Contact: Amy Du 415-885-7547 Amy.du@ucsf.edu

Locations
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United States, California
University of California, San Francisco Recruiting
Oakland, California, United States, 94612
Contact: Sarah Chatfield    415-885-7547    hotflash@ucsfmedctr.org   
University of California, San Francisco Recruiting
San Francisco, California, United States, 94115
Contact: Traci Plaut    415-885-7547    hotflash@ucsfmedctr.org   
Contact: Amy Du    415-885-7547    hotflash@ucsfmedctr.org   
Sponsors and Collaborators
University of California, San Francisco
National Institute on Aging (NIA)
Investigators
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Principal Investigator: Alison Huang, MD, MPhil, MAS University of California, San Francisco

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Responsible Party: Alison Huang, Associate Professor of Medicine, University of California, San Francisco
ClinicalTrials.gov Identifier: NCT02714205     History of Changes
Other Study ID Numbers: 15-18472
First Posted: March 21, 2016    Key Record Dates
Last Update Posted: January 28, 2019
Last Verified: January 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Alison Huang, University of California, San Francisco:
Hot flash
Additional relevant MeSH terms:
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Hot Flashes
Flushing
Signs and Symptoms
Skin Manifestations
Nitroglycerin
Vasodilator Agents