Preference of Women With Recurrent Urinary Tract Infection for Vaginal Estradiol Tablet vs Cream

NCT ID: NCT05723601

Last Updated: 2024-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-12

Study Completion Date

2026-01-31

Brief Summary

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Vaginally applied estrogen has been shown to decrease the incidence of Recurrent Urinary Tract Infection (rUTI) in post-menopausal women. However, prior studies have shown the compliance rate for topical estrogen cream is low. The vaginal estradiol tablet has been shown to be preferred by patients being treated for genitourinary syndrome of menopause and has improved compliance. There are no studies looking at the preference of post-menopausal women with rUTI for vaginal estradiol tablet as an alternative to vaginal estradiol cream.

Detailed Description

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This study is a cross-over randomized study to assess preference. Participants will be in the study for 6 months, they will use vaginal estradiol cream for 3 months and vaginal estradiol tablet for 3 months. Patients who meet diagnostic criteria for rUTI will be recruited. Group A participants will start with 3 months of cream and then switch to tablets. Group B will start with 3 months of tablets and switch to cream. In addition, participants may be started on other supplemental medications (Cranberry, D-mannose, methenamine) at the discretion of their provider. Patients will get monthly phone calls to assess for side effects, safety concerns, and symptoms of UTI.

Conditions

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Recurrent Urinary Tract Infection

Keywords

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vaginal estradiol cream vaginal estradiol tablet

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Investigators

Study Groups

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cream used first and then switch to tablets

participants will start with 3 months of cream and then switch to tablets

Group Type ACTIVE_COMPARATOR

Estradiol vaginal cream

Intervention Type DRUG

Participants will use vaginal estradiol cream for 3 months

Estradiol Vaginal Tablet

Intervention Type DRUG

Participants will use vaginal estradiol tablet for 3 months

tablets used first and switch to cream

participants will start with 3 months of tablets and switch to cream

Group Type ACTIVE_COMPARATOR

Estradiol vaginal cream

Intervention Type DRUG

Participants will use vaginal estradiol cream for 3 months

Estradiol Vaginal Tablet

Intervention Type DRUG

Participants will use vaginal estradiol tablet for 3 months

Interventions

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Estradiol vaginal cream

Participants will use vaginal estradiol cream for 3 months

Intervention Type DRUG

Estradiol Vaginal Tablet

Participants will use vaginal estradiol tablet for 3 months

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Women age 20-80 who are post-menopausal or have undergone surgical menopause. Post-menopausal defined as amenorrhea for ≥ 1 year, or surgical menopause through bilateral oophorectomy, or menopausal symptoms for ≥ 1 year in women with prior hysterectomy
* New or previous diagnosis of recurrent Urinary Tract Infections (rUTI) (3 or more UTIs in the past year or 2 or more UTIs in the last 6 months) Must have at least one culture documented UTI, the remaining can be documented by urinalysis showing nitrites and leukocyte esterase.
* Not currently taking daily prophylactic antibiotics
* Willing to use vaginal estrogen for prevention of recurrent UTIs

Exclusion Criteria

* Interstitial cystitis or bladder pain syndrome, nephrolithiasis, genitourinary abnormalities, fistula, history of renal transplant or anatomic abnormality of the kidney
* Fecal incontinence, intermittent catheterization or indwelling catheter, poorly controlled DM, urothelial cancer, estrogen-sensitive cancer including active breast cancer
* Recent urologic surgery within 3 months
* Inability to retain vaginal tablet (ex due to advanced prolapse, history of colpocleisis)
* Other medical reasons that are deemed incompatible with vaginal estrogen treatment
* Use of vaginal estrogen in the past 1 month- patients can be recruited after a 1 month wash-out period
* Inability to follow up at clinic study site to give sample, for example due to transportation issues
* Organ transplant patients
* Patients on systemic hormone replacement therapy (HRT)
Minimum Eligible Age

20 Years

Maximum Eligible Age

80 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Wake Forest University Health Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Candace Parker-Autry, MD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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Wake Forest University Health Sciences

Winston-Salem, North Carolina, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Martina Gabra, MD

Role: CONTACT

Phone: 336-713-4098

Email: [email protected]

Sachin Vyas, PhD

Role: CONTACT

Phone: 336-713-4098

Email: [email protected]

Facility Contacts

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Martina Gabra, MD

Role: primary

Sachin Vyas, PhD

Role: backup

References

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Walters, M.D. and M.M. Karram, Urogynecology and Pelvic Reconstructive surgery. 2022: Mosby Elsevier.

Reference Type BACKGROUND

Minkin MJ, Maamari R, Reiter S. Improved compliance and patient satisfaction with estradiol vaginal tablets in postmenopausal women previously treated with another local estrogen therapy. Int J Womens Health. 2013;5:133-9. doi: 10.2147/IJWH.S41897. Epub 2013 Mar 15.

Reference Type BACKGROUND
PMID: 23526171 (View on PubMed)

Ferrante KL, Wasenda EJ, Jung CE, Adams-Piper ER, Lukacz ES. Vaginal Estrogen for the Prevention of Recurrent Urinary Tract Infection in Postmenopausal Women: A Randomized Clinical Trial. Female Pelvic Med Reconstr Surg. 2021 Feb 1;27(2):112-117. doi: 10.1097/SPV.0000000000000749.

Reference Type BACKGROUND
PMID: 31232721 (View on PubMed)

Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993 Sep 9;329(11):753-6. doi: 10.1056/NEJM199309093291102.

Reference Type BACKGROUND
PMID: 8350884 (View on PubMed)

Boris S, Suarez JE, Vazquez F, Barbes C. Adherence of human vaginal lactobacilli to vaginal epithelial cells and interaction with uropathogens. Infect Immun. 1998 May;66(5):1985-9. doi: 10.1128/IAI.66.5.1985-1989.1998.

Reference Type BACKGROUND
PMID: 9573080 (View on PubMed)

O'Hanlon DE, Moench TR, Cone RA. Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota. PLoS One. 2013 Nov 6;8(11):e80074. doi: 10.1371/journal.pone.0080074. eCollection 2013.

Reference Type BACKGROUND
PMID: 24223212 (View on PubMed)

Anger J, Lee U, Ackerman AL, Chou R, Chughtai B, Clemens JQ, Hickling D, Kapoor A, Kenton KS, Kaufman MR, Rondanina MA, Stapleton A, Stothers L, Chai TC. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. J Urol. 2019 Aug;202(2):282-289. doi: 10.1097/JU.0000000000000296. Epub 2019 Jul 8.

Reference Type BACKGROUND
PMID: 31042112 (View on PubMed)

Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001500. doi: 10.1002/14651858.CD001500.pub2.

Reference Type BACKGROUND
PMID: 17054136 (View on PubMed)

Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol. 1999 May;180(5):1072-9. doi: 10.1016/s0002-9378(99)70597-1.

Reference Type BACKGROUND
PMID: 10329858 (View on PubMed)

Weissmann-Brenner A, Bayevsky T, Yoles I. Compliance to vaginal treatment-tablets versus cream: a retrospective 9 years study. Menopause. 2017 Jan;24(1):73-76. doi: 10.1097/GME.0000000000000729.

Reference Type BACKGROUND
PMID: 27648663 (View on PubMed)

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015 Apr;40(4):277-83.

Reference Type BACKGROUND
PMID: 25859123 (View on PubMed)

Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011 Oct;5(5):316-22. doi: 10.5489/cuaj.11214. No abstract available.

Reference Type BACKGROUND
PMID: 22031610 (View on PubMed)

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986 Jan;24(1):67-74. doi: 10.1097/00005650-198601000-00007.

Reference Type BACKGROUND
PMID: 3945130 (View on PubMed)

Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes. 2004 Feb 26;2:12. doi: 10.1186/1477-7525-2-12.

Reference Type BACKGROUND
PMID: 14987333 (View on PubMed)

Rioux JE, Devlin MC, Gelfand MM, Steinberg WM, Hepburn DS. 17beta-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal atrophic vaginitis. Menopause. 2018 Nov;25(11):1208-1213. doi: 10.1097/GME.0000000000001220.

Reference Type BACKGROUND
PMID: 30358715 (View on PubMed)

Other Identifiers

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IRB00092892

Identifier Type: -

Identifier Source: org_study_id