Safety/Efficacy Study Comparing the Misoprostol Vaginal Insert to Cervidil for Cervical Ripening and Induction of Labor

NCT ID: NCT00308711

Last Updated: 2012-06-25

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

1308 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-04-30

Study Completion Date

2007-08-31

Brief Summary

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The purpose of this study is to determine whether the misoprostol vaginal insert (50 mcg and 100 mcg) can safely and effectively speed time to vaginal delivery compared to Cervidil (R) in women who need to have cervical ripneing and induction of labor.

Detailed Description

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Induction of labor is required in approximately 20% of pregnant women. Although contractions can be brought on by oxytocin ("pitocin"), some women need help in softening the cervix, or mouth of the womb (uterus), before oxytocin can be started. Prostaglandins have been shown to ripen, or soften, the cervix; at present, the only prostaglandin approved for marketing by FDA for this purpose is dinoprostone. Dinoprostone can be delivered in several ways; one method is to use a polymer vaginal insert that slowly releases the dinoprostone directly to the cervical tissues. This product is called Cervidil (R) and has been marketed for more than 10 years in the United States. Misoprostol is another form of prostaglandin that is approved for protecting the stomach and intestinal lining for patients taking NSAIDs. Misoprostol has also been used by many obstetricians for cervical ripening and inducing contractions, but, it is not approved by FDA for this purpose.

The same company that makes the Cervidil polymer insert has made an insert that will slowly release misoprostol. This study will determine whether this investigational insert containing misoprostol will decrease time to vaginal delivery compared to Cervidil. Two different doses of misoprostol will be tested (50 micrograms and 100 micrograms); each vaginal insert will gradually release a small, controlled amount of misoprostol over up to 24 hours.

Comparator: The Cervidil (R) vaginal insert containing dinoprostone will be the comparator in this study.

Conditions

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Cervical Ripening Labor, Induced

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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MVI 100

Misoprostol vaginal insert 100 mcg over 24h

Group Type EXPERIMENTAL

Misoprostol vaginal insert 100 mcg

Intervention Type DRUG

Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.

MVI 50

Misoprostol vaginal insert 50 mcg over 24h

Group Type EXPERIMENTAL

Misoprostol vaginal insert 50 mcg

Intervention Type DRUG

Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.

Cervidil 10 mg vaginal insert

Cervidil 10 mg over 24h

Group Type ACTIVE_COMPARATOR

Dinoprostone vaginal insert (Cervidil)

Intervention Type DRUG

Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.

Interventions

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Misoprostol vaginal insert 100 mcg

Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.

Intervention Type DRUG

Misoprostol vaginal insert 50 mcg

Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.

Intervention Type DRUG

Dinoprostone vaginal insert (Cervidil)

Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.

Intervention Type DRUG

Other Intervention Names

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Misopess(TM) Misopess(TM) Propess(R) 10 mg dinoprostone vaginal insert

Eligibility Criteria

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Inclusion Criteria

* Pregnant women at least 36 weeks gestation requiring cervical ripening and induction of labor

Exclusion Criteria

* No uterine scar (no previous delivery by cesarean section)
* No multiple gestation
* No condition that disallows use of prostaglandins for induction of labor
* No more than 3 previous vaginal births beyond 24 weeks gestation
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Ferring Pharmaceuticals

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Helen Colquhoun, MD

Role: STUDY_DIRECTOR

Locations

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University of Alabama at Birmingham Medical Center

Birmingham, Alabama, United States

Site Status

Banner Desert Medical Center

Mesa, Arizona, United States

Site Status

Maricopa Medical Center

Phoenix, Arizona, United States

Site Status

Arizona Wellness Center for Women

Phoenix, Arizona, United States

Site Status

Tuscon Medical Center

Tucson, Arizona, United States

Site Status

Long Beach Memorial Medical Center

Long Beach, California, United States

Site Status

UCI Medical Center

Orange, California, United States

Site Status

Santa Clara Valley Medical Center

San Jose, California, United States

Site Status

Christiana Care Health System

Newark, Delaware, United States

Site Status

Bayfront Medical Center

St. Petersburg, Florida, United States

Site Status

University of Florida Health Sciences Center

Tampa, Florida, United States

Site Status

St. Mary's Medical Center

West Palm Beach, Florida, United States

Site Status

Northside Hospital

Alpharetta, Georgia, United States

Site Status

Hurley Medical Center

Flint, Michigan, United States

Site Status

University of Minnesota Medical Center

Minneapolis, Minnesota, United States

Site Status

St. Elizabeth Regional Medical Center

Lincoln, Nebraska, United States

Site Status

Morristown Memorial Hospital

Morristown, New Jersey, United States

Site Status

University of New Mexico Medical Center

Albuquerque, New Mexico, United States

Site Status

United Health Services Hospitals, Inc.

Johnson City, New York, United States

Site Status

Winthrop-South Nassau University Health Center

Mineola, New York, United States

Site Status

NYU School of Medicine

New York, New York, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Jacobi Medical Center

The Bronx, New York, United States

Site Status

Women's Health Alliance

Winston-Salem, North Carolina, United States

Site Status

University of Cincinnati Holmes Hospital

Cincinnati, Ohio, United States

Site Status

Ohio State University Medical Center

Columbus, Ohio, United States

Site Status

Miami Valley Hospital

Dayton, Ohio, United States

Site Status

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, United States

Site Status

Legacy Center for Maternal-Fetal Medicine

Portland, Oregon, United States

Site Status

Abington Memorial Hospital

Abington, Pennsylvania, United States

Site Status

Lehigh Valley Medical Center

Allentown, Pennsylvania, United States

Site Status

Temple University Hospital

Philadelphia, Pennsylvania, United States

Site Status

University of Pittsburgh - Magee Women's Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Lankenau Hospital

Wynnewood, Pennsylvania, United States

Site Status

Greenville Hospital System

Greenville, South Carolina, United States

Site Status

Trident Health System

North Charleston, South Carolina, United States

Site Status

Erlanger Hospital

Chattanooga, Tennessee, United States

Site Status

University of Tennesse Medical Center

Knoxville, Tennessee, United States

Site Status

Baptist Memorial Hospital

Memphis, Tennessee, United States

Site Status

Methodist Charlton Medical Center

Dallas, Texas, United States

Site Status

University of Texas Health Sciences Center at Houston

Houston, Texas, United States

Site Status

Kings Daughters Clinic

Temple, Texas, United States

Site Status

McKay-Dee Hospital

Ogden, Utah, United States

Site Status

St. Mark's Hospital

Salt Lake City, Utah, United States

Site Status

University of Utah Health Science Center

Salt Lake City, Utah, United States

Site Status

Jordan Valley Hospital

West Jordan, Utah, United States

Site Status

Pioneer Valley Hospital

West Valley City, Utah, United States

Site Status

Overlake Hospital Medical Center

Bellevue, Washington, United States

Site Status

Saint Clare's Hospital

Weston, Wisconsin, United States

Site Status

Women's Health Centre/General Hospital/Eastern Health

St. John's, Newfoundland and Labrador, Canada

Site Status

IWK Health Centre and Dalhousie University

Halifax, Nova Scotia, Canada

Site Status

University of Saskatchewan Royal University Hospital

Saskatoon, Saskatchewan, Canada

Site Status

Countries

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United States Canada

References

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Castaneda CS, Izquierdo Puente JC, Leon Ochoa RA, Plasse TF, Powers BL, Rayburn WF. Misoprostol dose selection in a controlled-release vaginal insert for induction of labor in nulliparous women. Am J Obstet Gynecol. 2005 Sep;193(3 Pt 2):1071-5. doi: 10.1016/j.ajog.2005.06.072.

Reference Type BACKGROUND
PMID: 16157114 (View on PubMed)

Rayburn WF, Powers BL, Plasse TF, Carr D, Di Spirito M. Pharmacokinetics of a controlled-release misoprostol vaginal insert at term. J Soc Gynecol Investig. 2006 Feb;13(2):112-7. doi: 10.1016/j.jsgi.2005.10.004.

Reference Type BACKGROUND
PMID: 16443504 (View on PubMed)

Ewert K, Powers B, Robertson S, Alfirevic Z. Controlled-release misoprostol vaginal insert in parous women for labor induction: a randomized controlled trial. Obstet Gynecol. 2006 Nov;108(5):1130-7. doi: 10.1097/01.AOG.0000239100.16166.5a.

Reference Type BACKGROUND
PMID: 17077234 (View on PubMed)

Wing DA; Misoprostol Vaginal Insert Consortium. Misoprostol vaginal insert compared with dinoprostone vaginal insert: a randomized controlled trial. Obstet Gynecol. 2008 Oct;112(4):801-12. doi: 10.1097/AOG.0b013e318187042e.

Reference Type RESULT
PMID: 18827122 (View on PubMed)

Pevzner L, Rayburn WF, Rumney P, Wing DA. Factors predicting successful labor induction with dinoprostone and misoprostol vaginal inserts. Obstet Gynecol. 2009 Aug;114(2 Pt 1):261-267. doi: 10.1097/AOG.0b013e3181ad9377.

Reference Type RESULT
PMID: 19622986 (View on PubMed)

Hawkins JS, Stephenson M, Powers B, Wing DA. Diabetes mellitus: an independent predictor of duration of prostaglandin labor induction. J Perinatol. 2017 May;37(5):488-491. doi: 10.1038/jp.2016.270. Epub 2017 Jan 26.

Reference Type DERIVED
PMID: 28125096 (View on PubMed)

Brennan MC, Pevzner L, Wing DA, Powers BL, Rayburn WF. Retention of dinoprostone vaginal insert beyond 12 hours for induction of labor. Am J Perinatol. 2011 Jun;28(6):479-84. doi: 10.1055/s-0030-1271208. Epub 2011 Jan 11.

Reference Type DERIVED
PMID: 21225563 (View on PubMed)

Other Identifiers

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Miso-Obs-004

Identifier Type: -

Identifier Source: org_study_id

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