MsFLASH-03: Comparative Efficacy of Low-Dose Estradiol and Venlafaxine XR for Treatment of Menopausal Symptoms
NCT ID: NCT01418209
Last Updated: 2014-08-27
Study Results
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View full resultsBasic Information
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COMPLETED
NA
339 participants
INTERVENTIONAL
2011-11-30
2013-01-31
Brief Summary
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
QUADRUPLE
Study Groups
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Low-dose 17-ß-estradiol with progesterone taper
Low-dose 17-ß-estradiol with progesterone taper
Low-dose 17-ß-estradiol oral (by mouth), 0.5 mg once per day for 8 (eight) weeks. 17-ß-estradiol is approved by the US Food and Drug Administration (FDA) and is indicated for the treatment of menopausal symptoms. ß is the Greek symbol for beta; the symbol and the word are used interchangeably. The 8 week estradiol treatment is followed by 14 days (2 weeks) of progesterone taper (as medroxy-progesterone 10 mg/day).
Venlafaxine XR
Venlafaxine XR
Venlafaxine oral (by mouth) 37.5 mg once per day for 1 (one) week, then 75 mg once per day for 7 (seven) weeks. Venlafaxine XR should not be taken while also taking monoamine oxidase inhibitors (MAOIs). Venlafaxine XR is approved by the US Food and Drug Administration (FDA) for treatment of depression, generalized anxiety disorder, social anxiety disorder, and panic disorder, and is available by prescription. Venlafaxine XR is not FDA-approved for the treatment of hot flashes, although prior studies have indicated that it is useful for treating hot flashes and vasomotor symptoms. After the 8-week venlafaxine XR study treatment period, women will receive a tapering dose of venlafaxine XR 37.5 mg once per day for 14 days (2 weeks).
Placebo
Placebo
The placebo is an inactive pill that looks like the active medication.
Interventions
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Low-dose 17-ß-estradiol with progesterone taper
Low-dose 17-ß-estradiol oral (by mouth), 0.5 mg once per day for 8 (eight) weeks. 17-ß-estradiol is approved by the US Food and Drug Administration (FDA) and is indicated for the treatment of menopausal symptoms. ß is the Greek symbol for beta; the symbol and the word are used interchangeably. The 8 week estradiol treatment is followed by 14 days (2 weeks) of progesterone taper (as medroxy-progesterone 10 mg/day).
Venlafaxine XR
Venlafaxine oral (by mouth) 37.5 mg once per day for 1 (one) week, then 75 mg once per day for 7 (seven) weeks. Venlafaxine XR should not be taken while also taking monoamine oxidase inhibitors (MAOIs). Venlafaxine XR is approved by the US Food and Drug Administration (FDA) for treatment of depression, generalized anxiety disorder, social anxiety disorder, and panic disorder, and is available by prescription. Venlafaxine XR is not FDA-approved for the treatment of hot flashes, although prior studies have indicated that it is useful for treating hot flashes and vasomotor symptoms. After the 8-week venlafaxine XR study treatment period, women will receive a tapering dose of venlafaxine XR 37.5 mg once per day for 14 days (2 weeks).
Placebo
The placebo is an inactive pill that looks like the active medication.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Postmenopausal or perimenopausal
* Having bothersome hot flashes
* In general good health
* Signed informed consent
Exclusion Criteria
* Recent use of any prescribed, over-the-counter or herbal therapies that are taken specifically for hot flashes
* Recent use of selective estrogen receptor modulators (SERMS) or aromatase inhibitors
* Recent use of psychotropic medications, including SSRIs (selective serotonin reuptake inhibitors), serotonin-norepinephrine reuptake inhibitors (SNRIs), MAOIs (monoamine oxidase inhibitors), and other antidepressants and anxiolytics.
* Known hypersensitivity or contraindications (reasons not to take) to venlafaxine, estrogen, or progestins
* Not using a medically approved method of birth control, if sexually active and not 12 or more months since last menstrual period
* Recent drug or alcohol abuse
* Lifetime diagnosis of psychosis or bipolar disorder
* Suicide attempt in the past 3 years or any current suicidal ideation
* Current major depression (assessed during screening)
* Pregnancy, intending pregnancy, or breast feeding
* History of:
* Pre-breast cancer or high-risk breast cancer condition
* Abnormal bleeding suggestive of endometrial pre-cancer or endometrial hyperplasia
* Asthma, diabetes mellitus, epilepsy, and migraine disorders that are not stable or under medical management
* Abnormal screening blood tests
* Current participation in another drug trial or intervention study
* Inability or unwillingness to complete the study procedures
40 Years
62 Years
FEMALE
Yes
Sponsors
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National Institute on Aging (NIA)
NIH
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
NIH
National Center for Complementary and Integrative Health (NCCIH)
NIH
Office of Research on Women's Health (ORWH)
NIH
Fred Hutchinson Cancer Center
OTHER
Responsible Party
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Katherine Guthrie
Principal Investigator
Principal Investigators
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Andrea Z LaCroix, PhD
Role: PRINCIPAL_INVESTIGATOR
Fred Hutchinson Cancer Center
Garnet Anderson, PhD
Role: PRINCIPAL_INVESTIGATOR
Fred Hutchinson Cancer Center
Katherine Guthrie, PhD
Role: PRINCIPAL_INVESTIGATOR
Fred Hutchinson Cancer Center
Lee S Cohen, MD
Role: PRINCIPAL_INVESTIGATOR
Massachusetts General Hospital/Harvard Medical School (HU)
Hadine Joffe, MD, MSc
Role: PRINCIPAL_INVESTIGATOR
Massachusetts General Hospital/Harvard Medical School (HU)
Katherine M Newton, PhD
Role: PRINCIPAL_INVESTIGATOR
Group Health Research Institute (GHRI)
Susan D Reed, MD
Role: PRINCIPAL_INVESTIGATOR
University of Washington/Group Health Research Institute (GHRI)
Janet Carpenter, PhD, RN, FAAN
Role: STUDY_DIRECTOR
Indiana University School of Medicine
Ellen W Freeman, PhD
Role: PRINCIPAL_INVESTIGATOR
University of Pennsylvania School of Medicine (UP)
Locations
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Massachusetts General Hospital, Harvard Medical School (HU)
Boston, Massachusetts, United States
Brigham and Women's Hospital
Chestnut Hill, Massachusetts, United States
University of Pennsylvania, UP
Philadelphia, Pennsylvania, United States
Group Health Research Institute (GHRI)
Seattle, Washington, United States
Countries
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References
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Ensrud KE, Larson JC, Guthrie KA, Crandall CJ, LaCroix AZ, Reed SD, Bhasin S, Mitchell CM, Joffe H. Changes in serum endogenous estrogen concentrations are mediators of the effect of low-dose oral estradiol on vasomotor symptoms. Menopause. 2022 Sep 1;29(9):1014-1020. doi: 10.1097/GME.0000000000002026. Epub 2022 Aug 16.
Hudson PL, Ling W, Wu MC, Hayward MR, Mitchell AJ, Larson J, Guthrie KA, Reed SD, Kwon DS, Mitchell CM. Comparison of the Vaginal Microbiota in Postmenopausal Black and White Women. J Infect Dis. 2021 Dec 1;224(11):1945-1949. doi: 10.1093/infdis/jiaa780.
Diem SJ, LaCroix AZ, Reed SD, Larson JC, Newton KM, Ensrud KE, Woods NF, Guthrie KA. Effects of pharmacologic and nonpharmacologic interventions on menopause-related quality of life: a pooled analysis of individual participant data from four MsFLASH trials. Menopause. 2020 Oct;27(10):1126-1136. doi: 10.1097/GME.0000000000001597.
Mitchell CM, Srinivasan S, Plantinga A, Wu MC, Reed SD, Guthrie KA, LaCroix AZ, Fiedler T, Munch M, Liu C, Hoffman NG, Blair IA, Newton K, Freeman EW, Joffe H, Cohen L, Fredricks DN. Associations between improvement in genitourinary symptoms of menopause and changes in the vaginal ecosystem. Menopause. 2018 May;25(5):500-507. doi: 10.1097/GME.0000000000001037.
Guthrie KA, Larson JC, Ensrud KE, Anderson GL, Carpenter JS, Freeman EW, Joffe H, LaCroix AZ, Manson JE, Morin CM, Newton KM, Otte J, Reed SD, McCurry SM. Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials. Sleep. 2018 Jan 1;41(1):zsx190. doi: 10.1093/sleep/zsx190.
Guthrie KA, LaCroix AZ, Ensrud KE, Joffe H, Newton KM, Reed SD, Caan B, Carpenter JS, Cohen LS, Freeman EW, Larson JC, Manson JE, Rexrode K, Skaar TC, Sternfeld B, Anderson GL. Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms. Obstet Gynecol. 2015 Aug;126(2):413-422. doi: 10.1097/AOG.0000000000000927.
Caan B, LaCroix AZ, Joffe H, Guthrie KA, Larson JC, Carpenter JS, Cohen LS, Freeman EW, Manson JE, Newton K, Reed S, Rexrode K, Shifren J, Sternfeld B, Ensrud K. Effects of estrogen and venlafaxine on menopause-related quality of life in healthy postmenopausal women with hot flashes: a placebo-controlled randomized trial. Menopause. 2015 Jun;22(6):607-15. doi: 10.1097/GME.0000000000000364.
Ensrud KE, Guthrie KA, Hohensee C, Caan B, Carpenter JS, Freeman EW, LaCroix AZ, Landis CA, Manson J, Newton KM, Otte J, Reed SD, Shifren JL, Sternfeld B, Woods NF, Joffe H. Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep. 2015 Jan 1;38(1):97-108. doi: 10.5665/sleep.4332.
Reed SD, Mitchell CM, Joffe H, Cohen L, Shifren JL, Newton KM, Freeman EW, Larson JC, Manson JE, LaCroix AZ, Guthrie KA. Sexual function in women on estradiol or venlafaxine for hot flushes: a randomized controlled trial. Obstet Gynecol. 2014 Aug;124(2 Pt 1):233-241. doi: 10.1097/AOG.0000000000000386.
Joffe H, Guthrie KA, LaCroix AZ, Reed SD, Ensrud KE, Manson JE, Newton KM, Freeman EW, Anderson GL, Larson JC, Hunt J, Shifren J, Rexrode KM, Caan B, Sternfeld B, Carpenter JS, Cohen L. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med. 2014 Jul;174(7):1058-66. doi: 10.1001/jamainternmed.2014.1891.
Newton KM, Carpenter JS, Guthrie KA, Anderson GL, Caan B, Cohen LS, Ensrud KE, Freeman EW, Joffe H, Sternfeld B, Reed SD, Sherman S, Sammel MD, Kroenke K, Larson JC, Lacroix AZ. Methods for the design of vasomotor symptom trials: the menopausal strategies: finding lasting answers to symptoms and health network. Menopause. 2014 Jan;21(1):45-58. doi: 10.1097/GME.0b013e31829337a4.
Other Identifiers
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