Use of Letrozole for Ectopic Pregnancy

NCT ID: NCT06354439

Last Updated: 2024-04-09

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

130 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-27

Study Completion Date

2026-12-31

Brief Summary

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A randomized clinical trial using oral letrozole 10mg/day for 7 days, for treating early cases of ectopic pregnancy, compared to intramuscular methotrexate

Detailed Description

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This is a multicenter randomized clinical trial on the use of letrozole in the medical treatment of tubal ectopic pregnancy. Tubal ectopic pregnancy is an abnormal pregnancy in the fallopian tube. They occurred in about 8% of all pregnancies presenting to the emergency department. Methotrexate (MTX), administered systemically (intramuscularly), is a widely used medication for the treatment of unruptured tubal ectopic pregnancies and has been recommended as first-line treatment for early cases of ectopic pregnancy.

Letrozole is an aromatase inhibitor and can suppress estradiol levels. Some recent studies have shown that its use can be applied in cases of ectopic pregnancy.

The aim of this non-inferiority clinical trial is to verify that letrozole treatment is non-inferior to methotrexate treatment in women with early ectopic pregnancy who are hemodynamically stable.

Conditions

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Ectopic Pregnancy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized clinical trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Due to the nature of the outcome and the interventions, blinding was not considered an issue.

Study Groups

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letrozole

Patients will receive 10mg of letrozole por 7 days.

Group Type EXPERIMENTAL

Letrozole tablets

Intervention Type DRUG

10 mg of letrozole PO for 7 days

Methotrexate

Patients will receive a single intramuscular dose of 100 mg of methotrexate.

Group Type ACTIVE_COMPARATOR

Methotrexate Sodium

Intervention Type DRUG

100 mg of methotrexate IM, single dose

Interventions

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Letrozole tablets

10 mg of letrozole PO for 7 days

Intervention Type DRUG

Methotrexate Sodium

100 mg of methotrexate IM, single dose

Intervention Type DRUG

Other Intervention Names

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letrozole 2,5mg - 4 tables methotrexate intramuscular (IM)

Eligibility Criteria

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Inclusion Criteria

* 18 years or older
* Diagnosis of ectopic pregnancy
* Desire for reproduction
* Ease of return
* Undetermined pregnancy location with abnormal hCG growth
* Presence of a heterogeneous adnexal mass on pelvic ultrasound suggestive of a tubal ectopic pregnancy with an hCG level ≤ 3000 mIU/ml
* Absence of fetal cardiac activity
* Average diameter of the adnexal mass ≤ 3.5 cm
* Hemodynamically stable
* No significant abdominal pain (i.e, \< 6 on a visual analog scale)

Exclusion Criteria

* Presence of a significant amount of free fluid in the pelvis (as assessed by the ultrasound technician)
* Allergy to methotrexate or letrozole
* A reduction in β-hCG ≥ 50% in 2 measurements with 48 hours between them or

≥ 85% in 4 days, or ≥ 95% in 7 days before randomization
* Abnormal liver function test (Alanine transaminase (ALT) ≥ 2 times the upper limit of normal)
* Abnormal renal function test (glomerular filtration rate ≤ 45 ml/min)
* Hemoglobin \<10 g/dl
* Platelets \<120.000/ml
* Presence of heterotopic pregnancy
* Do not wish to participate in the study.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Hospital de Clinicas de Porto Alegre

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ricardo F Savaris, MD, PhD

Role: STUDY_CHAIR

Hospital de Clínicas de Porto Alegre

Locations

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Hospital de Clínicas de Porto Alegre

Porto Alegre, Rio Grande do Sul, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Ricardo F Savaris, MD, PhD

Role: CONTACT

+55 51 997781966

Facility Contacts

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RICARDO F SAVARIS, MD,PHD

Role: primary

55 51 33598117

Michele S Savaris, BBA

Role: backup

555133598624

References

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Link CA, Maissiat J, Mol BW, Barnhart KT, Savaris RF. Diagnosing ectopic pregnancy using Bayes theorem: a retrospective cohort study. Fertil Steril. 2023 Jan;119(1):78-86. doi: 10.1016/j.fertnstert.2022.09.016. Epub 2022 Oct 26.

Reference Type BACKGROUND
PMID: 36307292 (View on PubMed)

Farquhar CM. Ectopic pregnancy. Lancet. 2005 Aug 13-19;366(9485):583-91. doi: 10.1016/S0140-6736(05)67103-6.

Reference Type BACKGROUND
PMID: 16099295 (View on PubMed)

Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. doi: 10.1093/humrep/17.12.3224.

Reference Type BACKGROUND
PMID: 12456628 (View on PubMed)

van Mello NM, Mol F, Ankum WM, Mol BW, van der Veen F, Hajenius PJ. Ectopic pregnancy: how the diagnostic and therapeutic management has changed. Fertil Steril. 2012 Nov;98(5):1066-73. doi: 10.1016/j.fertnstert.2012.09.040.

Reference Type BACKGROUND
PMID: 23084008 (View on PubMed)

Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21. BJOG. 2016 Dec;123(13):e15-e55. doi: 10.1111/1471-0528.14189. Epub 2016 Nov 3. No abstract available.

Reference Type BACKGROUND
PMID: 27813249 (View on PubMed)

Qian X, Li Z, Ruan G, Tu C, Ding W. Efficacy and toxicity of extended aromatase inhibitors after adjuvant aromatase inhibitors-containing therapy for hormone-receptor-positive breast cancer: a literature-based meta-analysis of randomized trials. Breast Cancer Res Treat. 2020 Jan;179(2):275-285. doi: 10.1007/s10549-019-05464-w. Epub 2019 Oct 12.

Reference Type BACKGROUND
PMID: 31606823 (View on PubMed)

Casper RF, Mitwally MF. Use of the aromatase inhibitor letrozole for ovulation induction in women with polycystic ovarian syndrome. Clin Obstet Gynecol. 2011 Dec;54(4):685-95. doi: 10.1097/GRF.0b013e3182353d0f.

Reference Type BACKGROUND
PMID: 22031258 (View on PubMed)

Auger N, Ayoub A, Wei SQ. Letrozole: future alternative to methotrexate for treatment of ectopic pregnancy? Fertil Steril. 2020 Aug;114(2):273-274. doi: 10.1016/j.fertnstert.2020.04.063. Epub 2020 Jul 1. No abstract available.

Reference Type BACKGROUND
PMID: 32622661 (View on PubMed)

Mitwally MF, Hozayen WG, Hassanin KMA, Abdalla KA, Abdalla NK. Aromatase inhibitor letrozole: a novel treatment for ectopic pregnancy. Fertil Steril. 2020 Aug;114(2):361-366. doi: 10.1016/j.fertnstert.2020.04.001. Epub 2020 Jul 1.

Reference Type BACKGROUND
PMID: 32622660 (View on PubMed)

Rezaei Z, Ghaemi M, Feizabad E, Ghavami B, Akbari Asbagh F, Davari Tanha F, Ebrahimi M, Khalaj Sereshki Z. The Effective Role of Adding Letrozole to Methotrexate in the Management of Tubal Ectopic Pregnancies, a Randomized Clinical Trial. Iran J Pharm Res. 2021 Fall;20(4):378-384. doi: 10.22037/ijpr.2021.115659.15461.

Reference Type BACKGROUND
PMID: 35194453 (View on PubMed)

Alabiad MA, Said WMM, Gad AH, Sharaf ElDin MTA, Khairy DA, Gobran MA, Shalaby AM, Samy W, Abdelsameea AA, Heraiz AI. Evaluation of Different Doses of the Aromatase Inhibitor Letrozole for the Treatment of Ectopic Pregnancy and Its Effect on Villous Trophoblastic Tissue. Reprod Sci. 2022 Oct;29(10):2983-2994. doi: 10.1007/s43032-022-00993-0. Epub 2022 Jun 14.

Reference Type BACKGROUND
PMID: 35701686 (View on PubMed)

Lipscomb GH, Gomez IG, Givens VM, Meyer NL, Bran DF. Yolk sac on transvaginal ultrasound as a prognostic indicator in the treatment of ectopic pregnancy with single-dose methotrexate. Am J Obstet Gynecol. 2009 Mar;200(3):338.e1-4. doi: 10.1016/j.ajog.2008.12.006.

Reference Type BACKGROUND
PMID: 19254596 (View on PubMed)

Other Identifiers

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77015224.6.1001.5327

Identifier Type: -

Identifier Source: org_study_id

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