Study of Leptin for the Treatment of Hypothalamic Amenorrhea

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Amgen
Information provided by (Responsible Party):
Beth Israel Deaconess Medical Center
ClinicalTrials.gov Identifier:
NCT00130117
First received: August 11, 2005
Last updated: January 4, 2012
Last verified: January 2012
  Purpose

The purpose of this study is to determine whether administration of an investigational medication called leptin (r-metHuLeptin) in replacement doses can improve bone health, reproductive function, hormone levels, immune function, and overall sense of well-being in women with hypothalamic (exercise-induced) amenorrhea (HA) who are being treated with oral contraceptive pills (OCPs), compared to placebo. Women with hypothalamic amenorrhea have low leptin levels. This study is based on the hypothesis that the relative leptin deficiency in women with hypothalamic (exercise-induced) amenorrhea may be the reason for the lack of menstrual cycles, hormone abnormalities, and bone loss associated with this condition.


Condition Intervention Phase
Amenorrhea
Drug: r-metHuLeptin
Drug: Oral Contraceptive Pills (OCPs)
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver)
Primary Purpose: Treatment
Official Title: Randomized, Double-blind, Placebo-controlled Trial of Human Recombinant Leptin (r-metHuLeptin) for the Treatment of Hypothalamic (Exercise-Induced) Amenorrhea

Resource links provided by NLM:


Further study details as provided by Beth Israel Deaconess Medical Center:

Primary Outcome Measures:
  • the difference between the placebo and leptin treated groups in the change in bone mineral density (BMD) at the anteroposterior (AP) spine from baseline to 36 weeks [ Time Frame: 36 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • hormone levels and bone markers [ Time Frame: 36 weeks ] [ Designated as safety issue: Yes ]
  • immune function [ Time Frame: 36 weeks ] [ Designated as safety issue: Yes ]
  • body composition (weight and body fat) [ Time Frame: 36 weeks ] [ Designated as safety issue: No ]
  • total, radial, hip bone density [ Time Frame: 36 weeks ] [ Designated as safety issue: Yes ]
  • resting metabolic rate [ Time Frame: 36 weeks ] [ Designated as safety issue: No ]
  • overall sense of well-being, appetite and food intake [ Time Frame: 36 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 34
Study Start Date: April 2010
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: r-metHuLeptin
    Starting dose: 0.08mg/kg once daily Subcutaneous injection.
    Drug: Oral Contraceptive Pills (OCPs)
    Sprintec taken orally once daily.
Detailed Description:

Leptin is a hormone secreted by fat cells under normal conditions and acts in the brain to regulate energy usage and hormone levels. Women with HA who do not have regular periods have low leptin levels and may also have other hormone abnormalities as well as loss of bone density (osteopenia or osteoporosis). This study will evaluate how leptin (a fat cell hormone that normally circulates in the blood) affects bone density, menstrual periods, hormone levels, bone metabolism (how bone forms and turns over), immune function (how well the body can fight infection), metabolic rate (how many calories are used at rest), and overall sense of well-being and appetite in women with HA (i.e. no regular menstrual periods due to low levels of pituitary hormones that regulate estrogen production from the ovary). It will also investigate whether leptin replacement can be used as an adjunct to the current standard of care for HA patients, i.e. OCPs.

Part A is a Randomized, placebo-controlled 36-week study. Part B is an Optional open-label 52-week study. There will also be an optional Reward Sub-study, including healthy controls, designed to investigate leptin's relation to reward processing by collecting participants' brain and behavioral responses to images (e.g., pictures of food vs. non-food). Brain responses will be collected and will also be assessed via functional Magnetic Resonance Imaging (fMRI).

Comparison: Part A = leptin-treated group to placebo-treated group and Part B optional sub study = leptin-treated group to health controls

  Eligibility

Ages Eligible for Study:   18 Years to 35 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion criteria for HA subjects

  • Hypothalamic amenorrhea of at least 6 months duration with low or normal LH and FSH, e.g. due to strenuous exercise (running >20 miles per week or equivalent) or low weight
  • Can be secondary HA OR primary HA with some pubertal development and normal screening labs
  • Age 18-35 years old
  • Body weight within +/- 15% of ideal body weight and stable for 6 months (no change > 5 lbs)
  • Baseline leptin <5 ng/mL (except for the Cognitive Sub-Study Baseline visit where baseline leptin will be greater than 5ng/mL)

Inclusion criteria for eumenorrheic controls for Reward Sub-study

  • Normal menstrual cycles (between 25 and 35 days)
  • Age 18-35
  • Body weight within +/- 15% of ideal body weight and stable 6 months (no change > 5 lbs)
  • Baseline leptin >5 ng/mL

Exclusion criteria:

  • We will exclude subjects with:
  • Significant medical history that may affect the concentrations of the hormones to studied or ability to participate in the study
  • renal or hepatic disease (creatinine > 1.4, AST/ALT > 2x upper limit of normal)
  • diagnosed diabetes mellitus
  • myocardial ischemia
  • malignancy (other than basal cell carcinoma of the skin or in situ carcinoma of the cervix)
  • malabsorption
  • alcoholism, drug abuse, or smoking
  • active eating disorder
  • depression or other psychiatric disease
  • anemia (Hb10 gm/dL on 2 occasions)
  • Conditions that are contraindicated for oral contraceptive use:
  • Thrombophlebitis or thromboembolic disorders
  • A past history of deep vein thrombophlebitis or thromboembolic disorders
  • Cerebral vascular or coronary artery disease
  • Known or suspected carcinoma of the breast
  • Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia
  • Undiagnosed abnormal genital bleeding
  • Hepatic adenomas or carcinomas
  • Cholestatic jaundice of pregnancy or jaundice with prior OCP use
  • Other endocrine causes of amenorrhea, e.g.
  • hyperprolactinemia
  • hypothyroidism or hyperthyroidism
  • Cushing's syndrome
  • congenital adrenal hyperplasia (elevated 17 OH progesterone)
  • polycystic ovarian syndrome (elevated androgens or LH/FSH ratio >1.5)
  • primary ovarian failure (elevated FSH)
  • On medications known to affect the hormones to be measured such as
  • glucocorticoids
  • anti seizure medications
  • thyroid hormones
  • estrogen (must be off at least 3 months prior to participating in the study)
  • A known history of anaphylaxis or anaphylactoid-like reactions, or a known hypersensitivity to E. Coli derived proteins
  • Breast feeding, pregnant, or wanting to become pregnant during the next 6 months.
  • We will screen for these conditions through a detailed history and systems review, physical examination, laboratory evaluation (as described above in Screening Methods), and EKG.
  • In the Reward Sub-study subjects will be asked to fill out a standard BIDMC MRI safety screening form prior to entering the magnet.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00130117

Locations
United States, Massachusetts
Beth Israel Deaconess Medical Center General Clinical Research Center
Boston, Massachusetts, United States, 02215
Sponsors and Collaborators
Beth Israel Deaconess Medical Center
Amgen
Investigators
Principal Investigator: Christos S Mantzoros, MD, ScD Beth Israel Deaconess Medical Center, Harvard Medical School
  More Information

Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Beth Israel Deaconess Medical Center
ClinicalTrials.gov Identifier: NCT00130117     History of Changes
Other Study ID Numbers: 2004P-000123
Study First Received: August 11, 2005
Last Updated: January 4, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by Beth Israel Deaconess Medical Center:
leptin
hypothalamic amenorrhea
exercise-induced amenorrhea
neuroendocrine function
bone metabolism

Additional relevant MeSH terms:
Amenorrhea
Menstruation Disturbances
Pathologic Processes
Contraceptive Agents
Contraceptives, Oral
Contraceptives, Oral, Combined
Contraceptive Agents, Female
Pharmacologic Actions
Physiological Effects of Drugs
Reproductive Control Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on October 21, 2014