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MF101, a Selective Estrogen Receptor a Modulator for the Treatment of Menopausal Hot Flushes: a Phase II Clinical Trial

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MF101, a Selective Estrogen Receptor a Modulator for the Treatment of Menopausal Hot Flushes: a Phase II Clinical Trial Menopause: The Journal of The North America Menopause Society Vol. 16, No. 3, pp. 458/465 DOI: 10.1097/gme.0b013e31818e64dd * 2009 by The North American menopause Society MF101, a selective estrogen receptor A modulator for the treatment of menopausal hot flushes: a phase II clinical trial Deborah Grady, MD, MPH,1,2 George F. Sawaya, MD,1 Karen C. Johnson, MD, MPH,3 William Koltun, MD,4 Rachel Hess, MD,5 Eric Vittinghoff, PhD,1 Margaret Kristof, MS, RN,1 Mary Tagliaferri, MD, LAC,6 Isaac Cohen, OMD, LAC,6 and Kristine E. Ensrud, MD, MPH7,8 Abstract Objective: To determine the optimal dose, safety, and efficacy of an estrogen receptor A selective Chinese herbal extract, menopausal formula 101 (MF101), for treating hot flushes. Methods: A randomized, blinded trial in 217 postmenopausal women with hot flushes randomized to 5 or 10 g/day of MF101 or placebo for 12 weeks. Results: The effects of 5 g/day of MF101 did not differ from those of placebo. After 12 weeks, the mean percent decrease in frequency of hot flushes in the 10 g/day group was 12.9% greater than that in the placebo group (P =0.15), the median percent decrease was 11.7% greater than that in the placebo group (P = 0.05), and the proportion of women with at least a 50% reduction in hot flushes was 16.2% greater than that in the placebo group (P =0.03). Conclusions: Treatment with 10 g/day of MF101 reduces the frequency of hot flushes. Trials with higher doses are planned. Key Words: Menopause Y Hot flush Y Estrogen receptor A selective estrogen. ore than half of women in the United States report the increased risk of uterine cancer,4 breast cancer, and hot flushes during the menopausal transition,1 and cardiovascular events associated with use of postmenopausal about 20% report that flushes are severe enough to hormone therapy.5,6 Selective serotonin reuptake inhibitors M 2 warrant treatment. Although estrogen is an effective treatment and gabapentin have modest efficacy for treatment of hot for vasomotor symptoms,3 many women are concerned about flushes, but these drugs have adverse effects that limit their use.7 Treatments that are both effective and safe would be Received July 17, 2008; revised and accepted September 18, 2008. welcome. One approach to attaining this goal is to develop 1 From the University of California, San Francisco, San Francisco, CA; selective estrogen-receptor modulators (SERMs) that are 2San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA; 3University of Tennessee Health Science Center, effective for relief of vasomotor symptoms but that do not Memphis, TN; 4Medical Center for Clinical Research, San Diego, CA; cause the adverse effects associated with current postmeno- 5 6 University of Pittsburgh, Pittsburgh, PA; Bionovo, Emeryville, CA; pausal estrogen therapies. 7University of Minnesota, Minneapolis, MN; and 8Minneapolis VA Medical Center, Minneapolis, MN. Menopausal formula 101 (MF101) is a combination of 22 Presented at the annual meeting of The North American Menopause herbs used in traditional Chinese medicine to treat vasomotor Society at Dallas, TX, on October 5, 2007. symptoms. MF101 is a SERM that has been shown to bind Funding/support: This study was sponsored by Bionovo, Inc, Emery- equally to estrogen receptor (ER)-> and to ER-A but to activate ville, CA. only ER-A transcriptional pathways.8 In addition, MF101 does Financial disclosure: Dr. Grady holds no stock, stock options or other not stimulate MCF-7 breast cancer cell proliferation or value in any pharmaceutical or biotechnology company and receives no speaker fees or honoraria. She has received support for research in the increase breast cancer tumor size or uterine weight in mouse 8 past 5 years via contract with the University of California, San Francisco xenograft models. Preliminary data in a small, uncontrolled from Berlex, Pfizer, Eli Lilly and Bionovo, Inc. She has been paid as a phase I trial showed that MF101 reduced the frequency of hot consultant to lead a Data and Safety Monitoring Board for Organon. Dr. Sawaya was funded as site PI by the sponsor, Bionovo, Inc. through flushes without causing adverse effects. specific formal contracts with University of California, San Francisco. We performed a multicenter, randomized, blinded, placebo- Dr. Johnson has received funding for research from Bionovo, Inc. controlled, phase II trial to investigate whether two doses Dr. Hess has received funding for research from Bionovo, Inc. Dr. Tagliaferri is a full time employee of Bionovo, Inc., the manufacturer of of MF101 were safe and effective in reducing the frequency the drug and sponsor of the study. She owns a substantial amount of and severity of hot flushes in generally healthy postmeno- stock in Bionovo, Inc. Dr. Cohen is a full time employee of Bionovo pausal women with moderate to severe hot flushes. Inc., the manufacturer and sponsor of MF101. He receives all his income from Bionovo Inc. and owns a substantial numbers of shares in the company. Dr. Ensrud has received research grant from Bionovo, METHODS Inc. via a contract administered by the University of Minnesota. Design and setting Address reprint requests to: Deborah Grady, MD, MPH, University of California, San Francisco, 1635 Divisadero St., Suite 600, San The Chinese Herbs in Menopausal Symptoms Francisco, CA 94115. E-mail: [email protected] (CHIMES) study was a multicenter, randomized, blinded, 458 Menopause, Vol. 16, No. 3, 2009 Copyright @ 2009 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. MF101: AN ER-A AGONIST FOR HOT FLUSHES placebo-controlled trial designed to determine whether two statistician, and shipped study medication to each clinical site. doses of MF101 were safe and effective in reducing the Study medication was allocated to eligible participants frequency and severity of hot flushes. The trial was coordi- sequentially according to the randomization scheme. nated at the University of California, San Francisco, and participants were recruited at six clinical sites in the United Study medications and blinding States. The institutional review boards of the coordinating MF101 is a combination of 22 herbs described in the Ap- center and of each clinical site approved the study protocol. pendix. A water-based extract of the formulation was de- canted, pressure filtered to remove insoluble materials, and Participants freeze dried. Carmel coloring and food dyes approved by the Eligible participants were generally healthy postmeno- FDA were added to the dry powder to reach a uniform color, pausal women 40 to 60 years old who reported at least seven and citrus flavorings and sweeteners were added to mask the moderate to severe hot flushes per day or 50 per week. We bitter taste of the herbs. Similar coloring and taste excipients excluded women with a history of breast, uterine, or ovarian were added to maltodextrin and cornstarch to produce a cancer; melanoma; venous thromboembolism; cardiovascular placebo powder with the same look, taste, and granularity as disease; or severe food or medicine allergies. We also the active medication. MF101 (US patent 60/667,887, excluded women reporting active liver or gallbladder disease, pending) is not licensed or registered as an herbal product abnormal uterine bleeding, and pregnancy or lactation and in the United States and is not approved for clinical use. those with mammogram, breast examination, Papanicolaou Participants received placebo or one of the two doses of test, or pelvic examination results suggestive of cancer. Wo- MF101 packaged as a powder and were instructed to dissolve men with endometrial thickness exceeding 5 mm measured the contents of the packet in at least 3 oz of noncitrus fluid by transvaginal ultrasound and those using medications and drink the beverage twice daily. All investigators, study known or suspected to affect hot flushes (estrogens, ta- staff, laboratory personnel, and participants were blinded to moxifen, raloxifene, progestins, selective serotonin reuptake study medication status. inhibitors, or gabapentin) were also excluded. From February to October 2006, women were recruited by Measurements direct, community-based media efforts. At screening, placebo At baseline, participants completed questionnaires regard- medication and diaries to record hot flushes, bleeding, and ing demographics, medical history, medications, quality of medication adherence were provided for a 1-week run-in life (SF-369), menopausal symptoms (Menopausal Quality of period. Participants who correctly completed their diaries, Life Scale10), and sexual function (Female Sexual Function took at least 80% of the placebo medication, and remained Index11). All participants had a physical examination, eligible after screening physical, sonographic, and laboratory including blood pressure and heart rate, a breast and pelvic examinations were randomized. examination, and, in women without a hysterectomy, a A data safety and monitoring board convened once before transvaginal ultrasound to measure endometrial double wall the trial began and three times during the trial to review data thickness. To evaluate safety, we measured serum hematol- on recruitment and retention, adherence, data quality, out- ogy, creatinine, urea nitrogen, liver function, and estradiol comes, and safety. At the conclusion of each meeting, the (double-antibody extraction radioimmunoassay using estra- board recommended that the study proceed. diol antiserum from Diagnostic Products Corporation, Los Role of the funding source Angeles, CA) and performed a urine analysis (Covance Bionovo (Emeryville, CA), maker of MF101 (US Food and Central Laboratory Services, Indianapolis, IN). All baseline Drug Administration [FDA] investigational new drug appli- measures were repeated after 12 weeks of treatment or at the cation no. 58,267), participated in the development of the final study visit. Hot flush frequency and severity were recorded on a diary protocol, provided study medications, and funded the study. 12 Data were collected, cleaned, and analyzed by the coordinat- modeled after a diary widely used in prior studies.
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