A Phase 3 interventional study of esmirtazapine and Placebo in Menopause and Vasomotor Symptoms, sponsored by Merck Sharp & Dohme LLC. Completed. Open to female participants aged 40 Years to 65 Years. Per ClinicalTrials.gov, last updated 2019-04-02.
Sponsored by Merck Sharp & Dohme LLC (part of Merck & Co., Inc) · Phase 3, Interventional, and Treatment
The most direct treatment of vasomotor symptions (hot flushes) may be by means of 5-HT2A receptor antagonist. Mirtazapine is a potent blocker of 5-HT2A receptors and was found to be effective in reducing the number and intensity of hot flushes in preliminary trials. Also several Selective Serotonin Reuptake Inhibitors (SSRIs) and other similar compounds have been investigated to manage hot flushes, confirming the role of the serotonergic system. In the present trial, the efficacy and safety of four different doses of esmirtazapine compared to placebo was investigated in women with moderate to severe vasomotor symptoms associated with the menopause. The primary study hypothesis was that esmirtazapine would show superior efficacy to placebo.
Merck Sharp & Dohme LLC is the lead sponsor of 2,160 studies on the registry; 134 are open to participants now.
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(FSH) levels >40 mIU/mL;
Exclusion Criteria:
respiratory, hematological, neurological, cardiovascular, or cerebrovascular disease that would put the subject at safety risk or mask measure of efficacy
Participants receive placebo, encapsulated tablets, orally (PO), once daily (QD) for up to 12 weeks
Drug: Placebo
Participants receive esmirtazapine 2.25 mg, encapsulated tablets, PO, QD for up to 12 weeks
Drug: esmirtazapine
Participants receive esmirtazapine 4.5 mg, encapsulated tablets, PO, QD for up to 12 weeks
Drug: esmirtazapine
Participants receive esmirtazapine 9 mg, encapsulated tablets, PO, QD for up to 12 weeks
Drug: esmirtazapine
Participants receive esmirtazapine 18 mg, encapsulated tablets, PO, QD for up to 12 weeks
Drug: esmirtazapine
Also known as: Esmirtazapine maleate, SCH 900265, Org 50081
Change From Baseline in Average Daily Frequency of Vasomotor Symptoms (Frequency Score A) at Week 4
Participants recorded the frequency of vasomotor symptoms (hot flushes) on an electronic diary card (LogPad®) on a daily basis during screening and treatment. Frequency score A was based on the number of moderate hot flushes + the number of severe hot flushes in one day. Baseline average was derived from, at most, 7 completely observed pre-treatment days. Weekly averages during treatment were calculated if at least 4 days with non-missing data were completely observed; if less than 4 days were completely observed, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
Time frame: Baseline and Week 4
Change From Baseline in Average Daily Frequency of Vasomotor Symptoms (Frequency Score A) at Week 12
Participants recorded the frequency of vasomotor symptoms (hot flushes) on a LogPad on a daily basis during screening and treatment. Frequency score A was based on the number of moderate hot flushes + the number of severe hot flushes in one day. Baseline average was derived from, at most, 7 completely observed pre-treatment days. Weekly averages during treatment were calculated if at least 4 days with non-missing data were completely observed; if less than 4 days were completely observed, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
Time frame: Baseline and Week 12
Change From Baseline in Average Daily Severity of Moderate/Severe Vasomotor Symptoms (Severity Score A) at Week 4
Participants recorded the severity of hot flushes on a LogPad on a daily basis during screening and treatment. The severity of hot flushes was defined as: mild (sensation of heat without sweating); moderate (sensation of heat with sweating, able to continue activity); and severe (sensation of heat with sweating, causing cessation of activity). Severity score A was calculated as the number of moderate hot flushes x 2 + the number of severe hot flushes x 3, divided by the total number of moderate and severe hot flushes. If no hot flushes were experienced, this was to be recorded as 'no sensation of heat'. Baseline values were based on, at most, 7 completely observed pre-treatment days. If less than 4 days were completely observed during treatment, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
Time frame: Baseline and Week 4
Change From Baseline in Average Daily Severity of Moderate/Severe Vasomotor Symptoms (Severity Score A) at Week 12
Participants recorded the severity of hot flushes on a LogPad on a daily basis during screening and treatment. The severity of hot flushes was defined as: mild (sensation of heat without sweating); moderate (sensation of heat with sweating, able to continue activity); and severe (sensation of heat with sweating, causing cessation of activity). Severity score A was calculated as the number of moderate hot flushes x 2 + the number of severe hot flushes x 3, divided by the total number of moderate and severe hot flushes. If no hot flushes were experienced, this was to be recorded as 'no sensation of heat'. Baseline values were based on, at most, 7 completely observed pre-treatment days. If less than 4 days were completely observed during treatment, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
Time frame: Baseline and Week 12
Change From Baseline in Vasomotor Symptoms Score Per Women's Health Questionnaire (WHQ) at Week 12
The WHQ is a 36-item, user-friendly, and rapid way of assessing nine domains of physical and emotional health for mid-aged women. Participants self-administered the WHQ questionnaire; scoring is based on a 4-point scale as follows: 'Yes definitely=1', 'Yes sometimes=2', 'No not much=3' and 'No not at all=4'. Each score is transformed to a value '1' for scores '1' and '2' and to a value '0' for scores '3' and '4'. Vasomotor symptoms encompass Items 19 and 27 of the 36 total items. The transformed sums of items 19+27 are divided by 2 to get the score; therefore, the domain ranges from 0 to 1, where lower values are better.
Time frame: Baseline and Week 12
| Milestone | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Started | 317 | 155 | 160 | 155 | 156 |
| Treated | 317 | 154 | 160 | 155 | 155 |
| Completed | 273 | 129 | 121 | 124 | 114 |
| Not completed | 44 | 26 | 39 | 31 | 42 |
| Withdrew: Adverse event | 16 | 10 | 25 | 23 | 35 |
| Withdrew: Lost to follow-up | 0 | 0 | 1 | 0 | 0 |
| Withdrew: Lack of efficacy | 22 | 9 | 6 | 4 | 4 |
| Withdrew: Participant uncooperative | 5 | 5 | 4 | 4 | 2 |
| Withdrew: Other | 1 | 1 | 3 | 0 | 0 |
| Withdrew: Never received drug | 0 | 1 | 0 | 0 | 1 |
Participants recorded the frequency of vasomotor symptoms (hot flushes) on an electronic diary card (LogPad®) on a daily basis during screening and treatment. Frequency score A was based on the number of moderate hot flushes + the number of severe hot flushes in one day. Baseline average was derived from, at most, 7 completely observed pre-treatment days. Weekly averages during treatment were calculated if at least 4 days with non-missing data were completely observed; if less than 4 days were completely observed, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
| Number of events | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Change From Baseline in Average Daily Frequency of Vasomotor Symptoms (Frequency Score A) at Week 4 | -3.9 ± 4.2 | -5.6 ± 3.8 | -6.0 ± 3.6 | -6.0 ± 4.0 | -6.0 ± 4.4 |
The WHQ is a 36-item, user-friendly, and rapid way of assessing nine domains of physical and emotional health for mid-aged women. Participants self-administered the WHQ questionnaire; scoring is based on a 4-point scale as follows: 'Yes definitely=1', 'Yes sometimes=2', 'No not much=3' and 'No not at all=4'. Each score is transformed to a value '1' for scores '1' and '2' and to a value '0' for scores '3' and '4'. Vasomotor symptoms encompass Items 19 and 27 of the 36 total items. The transformed sums of items 19+27 are divided by 2 to get the score; therefore, the domain ranges from 0 to 1, where lower values are better.
| Score on a scale | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Baseline | 0.984 ± 0.088 | 0.993 ± 0.060 | 0.985 ± 0.085 | 0.981 ± 0.114 | 0.985 ± 0.085 |
| Change from baseline | -0.151 ± 0.329 | -0.235 ± 0.355 | -0.256 ± 0.355 | -0.256 ± 0.372 | -0.246 ± 0.385 |
Participants recorded the frequency of vasomotor symptoms (hot flushes) on a LogPad on a daily basis during screening and treatment. Frequency score A was based on the number of moderate hot flushes + the number of severe hot flushes in one day. Baseline average was derived from, at most, 7 completely observed pre-treatment days. Weekly averages during treatment were calculated if at least 4 days with non-missing data were completely observed; if less than 4 days were completely observed, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
| number of events | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Change From Baseline in Average Daily Frequency of Vasomotor Symptoms (Frequency Score A) at Week 12 | -4.9 ± 4.8 | -6.2 ± 5.1 | -6.7 ± 3.9 | -6.9 ± 4.4 | -6.5 ± 4.4 |
Participants recorded the severity of hot flushes on a LogPad on a daily basis during screening and treatment. The severity of hot flushes was defined as: mild (sensation of heat without sweating); moderate (sensation of heat with sweating, able to continue activity); and severe (sensation of heat with sweating, causing cessation of activity). Severity score A was calculated as the number of moderate hot flushes x 2 + the number of severe hot flushes x 3, divided by the total number of moderate and severe hot flushes. If no hot flushes were experienced, this was to be recorded as 'no sensation of heat'. Baseline values were based on, at most, 7 completely observed pre-treatment days. If less than 4 days were completely observed during treatment, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
| score on a scale | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Change From Baseline in Average Daily Severity of Moderate/Severe Vasomotor Symptoms (Severity Score A) at Week 4 | -0.09 ± 0.23 | -0.11 ± 0.22 | -0.15 ± 0.25 | -0.16 ± 0.24 | -0.15 ± 0.24 |
Participants recorded the severity of hot flushes on a LogPad on a daily basis during screening and treatment. The severity of hot flushes was defined as: mild (sensation of heat without sweating); moderate (sensation of heat with sweating, able to continue activity); and severe (sensation of heat with sweating, causing cessation of activity). Severity score A was calculated as the number of moderate hot flushes x 2 + the number of severe hot flushes x 3, divided by the total number of moderate and severe hot flushes. If no hot flushes were experienced, this was to be recorded as 'no sensation of heat'. Baseline values were based on, at most, 7 completely observed pre-treatment days. If less than 4 days were completely observed during treatment, the averages of the previous week were carried forward (last observation carried forward, or LOCF). If the number of days observed in Week 1 were not sufficient, baseline values were carried forward.
| score on a scale | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Change From Baseline in Average Daily Severity of Moderate/Severe Vasomotor Symptoms (Severity Score A) at Week 12 | -0.12 ± 0.28 | -0.10 ± 0.27 | -0.15 ± 0.29 | -0.18 ± 0.26 | -0.17 ± 0.26 |
Collected over Non-serious adverse events were collected up to 7 days after the last dose of study drug; serious adverse events were collected for up to 30 days after the last dose of study drug.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo | — | 2/317 (0.6%) | 128/317 (40.4%) |
| Esmirtazapine 2.25 mg | — | 1/154 (0.6%) | 93/154 (60.4%) |
| Esmirtazapine 4.5 mg | — | 3/160 (1.9%) | 99/160 (61.9%) |
| Esmirtazapine 9 mg | — | 2/155 (1.3%) | 102/155 (65.8%) |
| Esmirtazapine 18mg | — | 0/155 (0%) | 123/155 (79.4%) |
| Event | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| Appendicitis perforatedGastrointestinal disorders | 0/317 | 1/154 | 0/160 | 0/155 | 0/155 |
| Oedema peripheralGeneral disorders | 0/317 | 0/154 | 0/160 | 1/155 | 0/155 |
| Vaginal lesionReproductive system and breast disorders | 0/317 | 0/154 | 0/160 | 1/155 | 0/155 |
| Large intestine perforationGastrointestinal disorders | 0/317 | 0/154 | 1/160 | 0/155 | 0/155 |
| Diabetic ketoacidosisMetabolism and nutrition disorders | 0/317 | 0/154 | 1/160 | 0/155 | 0/155 |
| Conversion disorderPsychiatric disorders | 0/317 | 0/154 | 1/160 | 0/155 | 0/155 |
| PyelonephritisInfections and infestations | 1/317 | 0/154 | 0/160 | 0/155 | 0/155 |
| ScarSkin and subcutaneous tissue disorders | 1/317 | 0/154 | 0/160 | 0/155 | 0/155 |
| Event | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmirtazapine 18mg |
|---|---|---|---|---|---|
| SomnolenceNervous system disorders | 19/317 | 33/154 | 37/160 | 44/155 | 50/155 |
| Weight increasedInvestigations | 18/317 | 25/154 | 24/160 | 32/155 | 45/155 |
| Increased appetiteMetabolism and nutrition disorders | 13/317 | 12/154 | 21/160 | 14/155 | 28/155 |
| HeadacheNervous system disorders | 54/317 | 11/154 | 13/160 | 14/155 | 19/155 |
| Dry mouthGastrointestinal disorders | 6/317 | 9/154 | 7/160 | 18/155 | 22/155 |
| FatigueGeneral disorders | 11/317 | 19/154 | 19/160 | 19/155 | 20/155 |
| ArthralgiaMusculoskeletal and connective tissue disorders | 16/317 | 5/154 | 9/160 | 14/155 | 5/155 |
| DizzinessNervous system disorders | 12/317 | 6/154 | 12/160 | 6/155 | 14/155 |
| LethargyNervous system disorders | 1/317 | 7/154 | 14/160 | 5/155 | 4/155 |
| InsomniaPsychiatric disorders | 13/317 | 6/154 | 10/160 | 6/155 | 13/155 |
All participants who received any study drug (placebo or esmertazapine), whether or not randomized.
| Age, Continuous(Years) | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmertazapine 18 mg | Total |
|---|---|---|---|---|---|---|
| Mean | 54.0 ± 4.4 | 53.4 ± 4.4 | 54.1 ± 4.2 | 54.9 ± 4.8 | 54.1 ± 4.5 | 54.1 ± 4.4 |
| Sex: Female, Male(Participants) | Placebo | Esmirtazapine 2.25 mg | Esmirtazapine 4.5 mg | Esmirtazapine 9 mg | Esmertazapine 18 mg | Total |
|---|---|---|---|---|---|---|
| Female | 317 | 154 | 160 | 155 | 155 | 941 |
| Male | 0 | 0 | 0 | 0 | 0 | 0 |
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Data sharing details ↗ · engagezone.msd.com
This study is completed, as verified in Mar 2019. You cannot join it, but the record below documents what was studied.
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Studies of the drug tested here: Mirtazapine