NES Gel-1, To Evaluate Nestorone Gel in Combination With Testosterone Gel

The purpose of this study is to determine the usefulness of two transdermal gels to be used in the future development for a male contraceptive...

Date First Received: September 27, 2005

Last Updated: February 19, 2008

Verified by: University of Washington, February 2008

Clinical Trial Phase: Phase 1 | Start Date: September 2005

Overall Status: Completed

Estimated Enrollment: 140

Brief Summary

Official Title: “A Randomized, Open Label Clinical Trial to Evaluate if Nestorone Gel Has Gonadotropin Suppressive Activity and if Nestorone in Combination With Testosterone Will Have an Additive Effect on Gonadotropin Suppression When Applied Transdermally in Healthy Men”

Condition Keyword(s):

The purpose of this study is to determine the usefulness of two transdermal gels to be used in the future development for a male contraceptive.

Study Type: Interventional

Study Design: Diagnostic, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study

Study Primary Completion Date: January 2007

Detailed Clinical Trial Description

The success of hormonal male contraception depends on the near complete suppression of spermatogenesis without producing any untoward effects on libido or other androgen-dependent functions or any other adverse events. The treatment with androgen alone has geen shown to be highly effective in Asian men but less effective in non-Asian men in clinical trials. To increase the efficacy of androgen alone treatment on spermatogenesis, combined regimens of a progestin and an androgen have shown promising results. The steady-state delivery of a progestin and an androgen by transdermal gel application would be a user-friendly delivery method as compared to injectable or implant approaches. Nestorone (NES) is a synthetic progestin that does not have any androgenic and estrogenic activity and is not expected to have some of the undesirable side effects of other drugs.

We propose to evaluate whether NES gel alone or in combination with T gel applied transdermally will result in more effective suppression of gonadotropins than NES or T gel applied alone in healthy men. Fifty healthy male subjects, age 18-50 will be enrolled at each center (2 sites).

Intervention(s) in this Clinical Trial

  • Drug: Nestorone gel
    • 2 to 8 mg Nestorone gel daily for 3 weeks depending on treatment group assignment
  • Drug: Testosterone Gel
    • 100 mg Testosterone gel daily for 3 weeks

Arms, Groups and Cohorts in this Clinical Trial

  • Active Comparator: 1
    • 100 mg Testosterone gel daily for 3 weeks
  • Active Comparator: 2
    • 2 mg Nestorone gel daily for 3 weeks
  • Active Comparator: 3
    • 4 mg Nestorone gel daily for 3 weeks
  • Active Comparator: 4
    • 100 mg Testosterone gel + 2 mg Nestorone gel
  • Active Comparator: 5
    • 100 mg Testosterone gel + 4 mg Nestorone gel
  • Active Comparator: 6
    • 100 mg Testosterone Gel + 6 mg Nestorone Gel daily for 3 weeks
  • Active Comparator: 7
    • 100 mg Testosterone Gel + 8 mg Nestorone gel daily for 3 weeks

Outcome Measures for this Clinical Trial

Primary Measures

  • - To determine the gonadotropin suppressive activity of Nestorone (NES) Gel at two doses and T gel at one dose alone or in combination over a 3-week period. Serum levels of gonadotropins will be assessed in all subjects.
    • Time Frame: 3 weeks
      Safety Issue?: No

Secondary Measures

  • To determine the effects on serum levels of total and free testosterone and SHBG and measure serum levels of NES gel.
    • Time Frame: 3 weeks
      Safety Issue?: No
  • Safety measured laboratory evaluations, vitals, pre- and post treatment physical exam results and PSA levels
    • Time Frame: 3 weeks
      Safety Issue?: Yes

Criteria for Participation in this Clinical Trial

Inclusion Criteria:

  • Healthy men
  • Aged 18-50 years
  • With normal clinical chemistry, serum levels of testosterone, PSA, gonadotropins within normal limits, and sperm concentration greater than 20 million/mL
  • Subject or his partner willing to use a recognized effective method of contraception

Exclusion Criteria:

  • Men not living in area of clinics
  • Clinically significant abnormal findings at screening
  • Elevated PSA greater than 4
  • Partners who are pregnant
  • Abnormal laboratory values, liver or kidney dysfunction
  • Sperm counts below 20 million/mL.
  • Use of androgens or body building substances within 6 months of enrollment,
  • Blood pressure greater than 140/90, history of hypertension, including hypertension controlled with treatment
  • History of primary testicular disease or disorder of the hypothalamic-pituitary axis
  • Hypersensitivity of progestins
  • History of venous thromboembolism
  • Benign or malignant liver tumors
  • Active liver disease, history of reproductive dysfunction including vasectomy or infertility
  • History of active or chronic cardiac, renal, hepatic or prostatic disease
  • Diabetes mellitus or morbid obesity (body weight greater than 120% of ideal body weight)
  • Known or suspected alcoholism or drug abuse
  • Known dermatitis or severe skin disorder
  • Men desiring fertility within 6 months or participating in competitive sports where drug screening for prohibited substances (including anabolic steroids) is routine will be advised of the relative and temporary hazards that participating in this study may have for their fertility or sporting status.

Gender Eligibility for this Clinical Trial: Male

Minimum Age for this Clinical Trial: 18 Years

Maximum Age for this Clinical Trial: 50 Years

Are Healthy Volunteers Accepted for this Clinical Trial?: Accepts Healthy Volunteers

Clinical Trial Sponsor Information

Lead Sponsor: University of Washington

Overall Clinical Trial Officials and Contacts

William J Bremner, MD, PhD Principal Investigator University of Washington  

Related Publications

References

Anawalt BD, Bebb RA, Bremner WJ, Matsumoto AM. A lower dosage levonorgestrel and testosterone combination effectively suppresses spermatogenesis and circulating gonadotropin levels with fewer metabolic effects than higher dosage combinations. J Androl. 1999 May-Jun;20(3):407-14.

Anderson RA, Kinniburgh D, Baird DT. Suppression of spermatogenesis by etonogestrel implants with depot testosterone: potential for long-acting male contraception. J Clin Endocrinol Metab. 2002 Aug;87(8):3640-9.

Bebb RA, Anawalt BD, Christensen RB, Paulsen CA, Bremner WJ, Matsumoto AM. Combined administration of levonorgestrel and testosterone induces more rapid and effective suppression of spermatogenesis than testosterone alone: a promising male contraceptive approach. J Clin Endocrinol Metab. 1996 Feb;81(2):757-62.

Brache V, Massai R, Mishell DR, Moo-Young AJ, Alvarez F, Salvatierra AM, Cochon L, Croxatto H, Robbins A, Faundes A. Ovarian function during use of Nestorone(R) subdermal implants. Contraception. 2000 Mar;61(3):199-204.

Cummings DE, Bremner WJ. Prospects for new hormonal male contraceptives. Endocrinol Metab Clin North Am. 1994 Dec;23(4):893-922. Review.

Diaz S, Schiappacasse V, Pavez M, Zepeda A, Moo-Young AJ, Brandeis A, Lahteenmaki P, Croxatto HB. Clinical trial with Nestorone subdermal contraceptive implants. Contraception. 1995 Jan;51(1):33-8.

Gonzalo IT, Swerdloff RS, Nelson AL, Clevenger B, Garcia R, Berman N, Wang C. Levonorgestrel implants (Norplant II) for male contraception clinical trials: combination with transdermal and injectable testosterone. J Clin Endocrinol Metab. 2002 Aug;87(8):3562-72.

Haukkamaa M, Laurikka-Routti M, Heikinheimo O, Moo-Young A. Contraception with subdermal implants releasing the progestin ST-1435: a dose-finding study. Contraception. 1992 Jan;45(1):49-55.

Handelsman DJ, Conway AJ, Howe CJ, Turner L, Mackey MA. Establishing the minimum effective dose and additive effects of depot progestin in suppression of human spermatogenesis by a testosterone depot. J Clin Endocrinol Metab. 1996 Nov;81(11):4113-21.

Kamischke A, Heuermann T, Kruger K, von Eckardstein S, Schellschmidt I, Rubig A, Nieschlag E. An effective hormonal male contraceptive using testosterone undecanoate with oral or injectable norethisterone preparations. J Clin Endocrinol Metab. 2002 Feb;87(2):530-9.

Kamischke A, Venherm S, Ploger D, von Eckardstein S, Nieschlag E. Intramuscular testosterone undecanoate and norethisterone enanthate in a clinical trial for male contraception. J Clin Endocrinol Metab. 2001 Jan;86(1):303-9.

Additional Information

Information obtained from ClinicalTrials.gov on September 05, 2008

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00229593

Study ID Number: 04-3792-D 02

ClinicalTrials.gov Identifier: NCT00229593

Health Authority: United States: Food and Drug Administration

http://depts.washington.edu/popctr/

http://gcrc.labiomed.org/endocrinology

http://www.labiomed.org

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