Uterine FibroidPhase 1NCT05986266
Evaluating Efficacy of Intravenous Carbetocin Versus Intramyometrial Injection of Adrenaline in Reducing Blood Loss
A Phase 1 study testing Carbetocin in people with Uterine Fibroid, run by Egymedicalpedia at 1 site in Egypt.
Trial summary
Uterine fibroids, affecting 20-50% of all women ,and are benign tumors that arise from myometrial cells of the uterine smooth muscle tissue. Although most are asymptomatic, fibroids can often cause abnormal uterine bleeding, iron deficiency anemia, pelvic pressure symptoms and pain Read more about this study
- Who is it for?
- Ages 25 months to 50 years, women only
- Conditions the study is for
- Uterine Fibroid
- What is being tested?
- Carbetocin
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 62 participants
- Where
- 1 siteEgypt
- Study dates
- 1 Feb 2023to 15 Sep 2023
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 months to 50 years
- Women only
- No healthy volunteers
- Child, Adult
Who may be able to join
- Women aged 25-50 years old.
- Women who will undergo abdominal myomectomy because of symptomatic stage 3-6 fibroids, according to FIGO staging (Laughlin-Tommaso et al., 2017), with the number of myomas not exceeding five based on the preoperative ultrasonography (US).
Who cannot join
- Women with previous myomectomy.
- Pregnant and postmenopausal women.
- Women with preoperative hemoglobin concentration <10 g/dL,
- women who are candidate for and choosing vaginal or laparoscopic myomectomy.
- History of preoperative embolization or hormone therapy (GnRH analogues), cervical and broad ligament myoma, number of myomas more than five on preoperative US, myoma FIGO stages 1,2,7 and 8 (Munro et al., 2011)
- Patients with allergy or contraindications to carbetocin or epinephrine, such as coronary artery disease, asthma, epilepsy, migraine, kidney, and hepatic disease.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Evaluating Efficacy of Intravenous Carbetocin Versus Intramyometrial Injection of Adrenaline in Reducing Blood Loss During Abdominal Myomectomy: A Randomized Controlled Trial
Uterine fibroids, affecting 20-50% of all women ,and are benign tumors that arise from myometrial cells of the uterine smooth muscle tissue. Although most are asymptomatic, fibroids can often cause abnormal uterine bleeding, iron deficiency anemia, pelvic pressure symptoms and pain
Read the detailed description
Women with myomatous uteri have an increased number of blood supply which may cause excessive bleeding during myomectomy. The excessive bleeding may result in blood transfusions and prolonged hospital stays. A variety of methods are used to reduce bleeding during myomectomy including preoperative administration of gonadotropin-releasing hormone (GnRH) agonists, uterine artery tourniquet, vaginal misoprostol, intravenous tranexamic acid, intramyometrial injections of bupivacaine plus adrenaline and vasopressin, chemical dissection with Mesna (sodium-2-mercaptoethanesulfonate), perioperative injection of ascorbic acid, and, recently, carbetocin.
Currently, there are several strategies for the treatment of fibroids. Still, myomectomy, the surgical removal of myomas, is an important treatment option for symptomatic leiomyomas, especially in women who wish to preserve their uteri.This can be accomplished via laparotomy, laparoscopy or hysteroscopy.
Oxytocin is a hormone secreted from the posterior pituitary and exerts its effect on the uterus by producing uterine contractions during labor and delivery. Because of this contractile feature, synthetic oxytocin analogs are used in the treatment of postpartum uterine atony and hemorrhage. Based on its ability to attenuate blood loss, oxytocin has been evaluated in gynecologic procedures, including hysterectomies, myomectomies, and endometrial resections. Although the expression of oxytocin receptors is thought to be strictly related to pregnancy, their presence has been demonstrated in the leiomyomatous uterus.
Carbetocin was first introduced to control postpartum hemorrhage, but its manageability and efficacy soon made it an interesting option for gynecologic surgeons. Given its longer half-life compared with oxytocin and its ample bioavailability, carbetocin could represent a very useful tool during myomectomy, administered either intravenously or intramuscularly Following promising reports on the effectiveness of carbetocin in reducing intraoperative blood loss, hemoglobin drop, and need for postoperative blood transfusions.
Adrenaline is a potent vasoconstrictive agent that has a high risk of cardiovascular effects if an intravascular instillation is performed. The vasoconstrictive effect of adrenaline on tissue lasts longer than that of vasopressin.
Bupivacaine is a local anesthetic that causes vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. Bupivacaine has shown to have a vasoconstrictive activity in concentrations of ≤ 0.25%, with duration of its action between 4 and 24 h when used for local infiltration. The use of a combination of bupivacaine and low dose of adrenaline in order to minimize the cardiovascular effects of the latest without interfering with the vasoconstrictive effects on haemostasis has been documented.
The myometrial injection of adrenaline plus bupivacaine was one of the evaluated methods showing significantly reduced blood loss and shorter duration of surgery compared to placebo
- Conditions
- Uterine Fibroid
- Being tested
- Carbetocin
- Medical subject headings
- Leiomyoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CarbetocinDrug
Also called Adrenaline
To compare efficacy of intravenous carbetocin to intramyometrial injection of adrenaline in decreasing intraoperative blood loss and need for blood transfusion during abdominal myomectomy.
| Study group | Role | What they receive |
|---|---|---|
| Group A | Active comparator | patients will receive carbetocin, The optimal carbetocin dose(IV or IM) is 100 mcg. The carbetocin group will receive 100 mcg IV carbetocin (Pabal; Ferring Pharmaceuticals) in 10 mL saline solution. The anesthesiologists will administrate carbetocin slowly over 5 minutes (at a rate of 2 mL/min) to maintain hemodynamic stability. Receives: Drug: Carbetocin |
| Group B | Experimental | patients will receive adrenalin, infiltration of the serosa and/or myometrium overlying the leiomyoma before uterine incision with a solution composed of 50 ml Bupivacaine HCL 0.25% and 0.5 mg of adrenaline.The anesthesiologist will be informed prior to the injection of the solution to ensure proper monitoring. The solution will be prepared just before the procedure. Before each infiltration, aspiration will be performed to avoid intravascular injection Receives: Drug: Carbetocin |
What is being measured
The primary outcome is the main question the study is designed to answer.
Intraoperative and Post operative bleeding(defined as blood loss ≥500 cc)
Compare efficacy of intravenous carbetocin to intramyometrial injection of adrenaline in reducing intraoperative blood loss during abdominal myomectomy Outcome of the study will be measured in terms of assessment of Hemoglobin level and Hematocrit level pre and post operatively.
Measured: First 2 hours after abdominal myomectomy
Secondary outcomes (1)
Side Effects Of the used drugs in the operation
- Need for blood transfusion.
- Duration of surgery.
- Operative complications.
- Post operative adverse effects such as allergy, cardiovascular disorders and pulmonary edema, etc.
Measured: First 24 hours after abdominal myomectomy
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Aug 2023
- Study start1 Feb 2023
- Primary completion30 Aug 2023
- Study completion15 Sep 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Uterine FibroidStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 62 participants (actual)
Sponsor and investigators
- Lead sponsor
- Egymedicalpedia
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Waleed Saber, Professor, Study chair, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05986266
- Sponsor's protocol ID
- Micheal Hany Monir
- Status last verified
- Oct 2023
- First submitted
- 1 Aug 2023
- Last updated
- 17 Oct 2023
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 17 Oct 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluating Efficacy of Intravenous Carbetocin Versus Intramyometrial Injection of Adrenaline in Reducing Blood Loss During Abdominal Myomectomy: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT05986266
- Acronym / sponsor ID
- Micheal Hany Monir
- Conditions
- Uterine Fibroid
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 62 participants (actual)
- Lead sponsor
- EgymedicalpediaIndustry (pharma, biotech, devices)
- Study start
- 1 Feb 2023 (actual)
- Primary completion
- 30 Aug 2023 (actual)
- Study completion
- 15 Sep 2023 (actual)
- First posted
- 14 Aug 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Uterine fibroids, affecting 20-50% of all women ,and are benign tumors that arise from myometrial cells of the uterine smooth muscle tissue. Although most are asymptomatic, fibroids can often cause abnormal uterine bleeding, iron deficiency anemia, pelvic pressure symptoms and pain
Detailed description
Women with myomatous uteri have an increased number of blood supply which may cause excessive bleeding during myomectomy. The excessive bleeding may result in blood transfusions and prolonged hospital stays. A variety of methods are used to reduce bleeding during myomectomy including preoperative administration of gonadotropin-releasing hormone (GnRH) agonists, uterine artery tourniquet, vaginal misoprostol, intravenous tranexamic acid, intramyometrial injections of bupivacaine plus adrenaline and vasopressin, chemical dissection with Mesna (sodium-2-mercaptoethanesulfonate), perioperative injection of ascorbic acid, and, recently, carbetocin.
Currently, there are several strategies for the treatment of fibroids. Still, myomectomy, the surgical removal of myomas, is an important treatment option for symptomatic leiomyomas, especially in women who wish to preserve their uteri.This can be accomplished via laparotomy, laparoscopy or hysteroscopy.
Oxytocin is a hormone secreted from the posterior pituitary and exerts its effect on the uterus by producing uterine contractions during labor and delivery. Because of this contractile feature, synthetic oxytocin analogs are used in the treatment of postpartum uterine atony and hemorrhage. Based on its ability to attenuate blood loss, oxytocin has been evaluated in gynecologic procedures, including hysterectomies, myomectomies, and endometrial resections. Although the expression of oxytocin receptors is thought to be strictly related to pregnancy, their presence has been demonstrated in the leiomyomatous uterus.
Carbetocin was first introduced to control postpartum hemorrhage, but its manageability and efficacy soon made it an interesting option for gynecologic surgeons. Given its longer half-life compared with oxytocin and its ample bioavailability, carbetocin could represent a very useful tool during myomectomy, administered either intravenously or intramuscularly Following promising reports on the effectiveness of carbetocin in reducing intraoperative blood loss, hemoglobin drop, and need for postoperative blood transfusions.
Adrenaline is a potent vasoconstrictive agent that has a high risk of cardiovascular effects if an intravascular instillation is performed. The vasoconstrictive effect of adrenaline on tissue lasts longer than that of vasopressin.
Bupivacaine is a local anesthetic that causes vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. Bupivacaine has shown to have a vasoconstrictive activity in concentrations of ≤ 0.25%, with duration of its action between 4 and 24 h when used for local infiltration. The use of a combination of bupivacaine and low dose of adrenaline in order to minimize the cardiovascular effects of the latest without interfering with the vasoconstrictive effects on haemostasis has been documented.
The myometrial injection of adrenaline plus bupivacaine was one of the evaluated methods showing significantly reduced blood loss and shorter duration of surgery compared to placebo
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Group A | Active comparator | Drug: Carbetocinpatients will receive carbetocin, The optimal carbetocin dose(IV or IM) is 100 mcg. The carbetocin group will receive 100 mcg IV carbetocin (Pabal; Ferring Pharmaceuticals) in 10 mL saline solution. The anesthesiologists will administrate carbetocin slowly over 5 minutes (at a rate of 2 mL/min) to maintain hemodynamic stability. |
| Group B | Experimental | Drug: Carbetocinpatients will receive adrenalin, infiltration of the serosa and/or myometrium overlying the leiomyoma before uterine incision with a solution composed of 50 ml Bupivacaine HCL 0.25% and 0.5 mg of adrenaline.The anesthesiologist will be informed prior to the injection of the solution to ensure proper monitoring. The solution will be prepared just before the procedure. Before each infiltration, aspiration will be performed to avoid intravascular injection |
Who may qualify
- Ages
- 25 months to 50 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (2 listed)
- Women aged 25-50 years old.
- Women who will undergo abdominal myomectomy because of symptomatic stage 3-6 fibroids, according to FIGO staging (Laughlin-Tommaso et al., 2017), with the number of myomas not exceeding five based on the preoperative ultrasonography (US).
Key exclusion criteria (6 listed)
- Women with previous myomectomy.
- Pregnant and postmenopausal women.
- Women with preoperative hemoglobin concentration <10 g/dL,
- women who are candidate for and choosing vaginal or laparoscopic myomectomy.
- History of preoperative embolization or hormone therapy (GnRH analogues), cervical and broad ligament myoma, number of myomas more than five on preoperative US, myoma FIGO stages 1,2,7 and 8 (Munro et al., 2011)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| CarbetocinAlso: AdrenalineTo compare efficacy of intravenous carbetocin to intramyometrial injection of adrenaline in decreasing intraoperative blood loss and need for blood transfusion during abdominal myomectomy. | Drug | Group A, Group B |
Primary outcome
Intraoperative and Post operative bleeding(defined as blood loss ≥500 cc)
Time frame: First 2 hours after abdominal myomectomy
Compare efficacy of intravenous carbetocin to intramyometrial injection of adrenaline in reducing intraoperative blood loss during abdominal myomectomy Outcome of the study will be measured in terms of assessment of Hemoglobin level and Hematocrit level pre and post operatively.
1 secondary outcome
Side Effects Of the used drugs in the operation
Time frame: First 24 hours after abdominal myomectomy
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 Oct 2023.
- Individual participant dataSharing planned: Undecided
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Life Study: Lifestyle Intervention in Fibroid Elimination
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Office Hysteroscopy Versus Operating-room Hysteroscopy for Uterine Lesions
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Waleed Saber, Professor study chair
Cairo University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Carbetocin in people with Uterine Fibroid, run by Egymedicalpedia at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 17 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Intraoperative and Post operative bleeding(defined as blood loss ≥500 cc) (time frame: First 2 hours after abdominal myomectomy). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Oct 2023.