11 Androgenic AEs by Maximum Free T P hase II and Phase III % of patients Placebo N= 703 TTS Upper Decile N=58 Acne710.3 Alopecia2.73.5 Facial Hair55.2.

Slides:



Advertisements
Similar presentations
Women's Health Initiative
Advertisements

for Bio-Identical Hormones
Your Institution Here Your Institution Here Cardiovascular Disease in Women: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulators.
Testosterone Effect on Lipids,Bone Density and Breast Cancer Incidence The “ABC Study”
Protecting the heart and the kidney: Implications from the SHARP trial Dr. Christina Reith University of Oxford United Kingdom.
TROPHY TRial Of Preventing HYpertension. High-normal BP increases CV risk Vasan RS et al. N Engl J Med. 2001;345: Incidence of CV events in women.
1 Efficacy of Testosterone Transdermal System (TTS) for Treatment of HSDD in Surgically Menopausal Women on Concomitant Estrogen Daniel Davis, MD, MPH.
Slide Source: Lipids Online Slide Library Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) 5804 patients aged 70–82.
Cardiovascular Disease in Women Module VI: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulators (SERMs)
Lancet : doi: /S (08)60104-X Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from.
Effects of Conjugated Equine Estrogen in Postmenopausal Women with Hysterectomy The Women’s Health Initiative Randomized Controlled Trial JAMA 2004;291:
An Academic Research Organization of Brigham and Women’s Hospital and Harvard Medical School LAPLACE-TIMI 57 Primary Results A Double-blind, Randomized,
11 Intrinsa ™ (testosterone transdermal system) Reproductive Health Drugs Advisory Committee Meeting Gaithersburg, MD December 2, 2004 Procter & Gamble.
COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Purpose To compare the efficacy of optimal medical therapy (OMT)
Hormonal Replacement Therapy for postmenopausal females: To give or not to give? Amna B. Buttar, MD, MS Assistant Professor of Clinical Medicine Indiana.
Hormone Replacement Therapy 5/11/07 5/11/07Tanu. History of HRT Approximately 100years of research and 80 years of clinical practice Ovarian extracts.
Pfizer Global Research & Development Sandwich CT13 9NJ Kent Introduction Sildenafil (Viagra  ) is an orally active, selective inhibitor of cGMP specific.
Slide Source: Lipids Online Slide Library Women’s Health Initiative: Trial of Estrogen plus Progestin 16,608 women randomized 16,608.
Fenofibrate Intervention and Event Lowering in Diabetes FIELDFIELD Presented at The American Heart Association Scientific Sessions, November 2005 Presented.
Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Trial MEGA Trial Presented at The American Heart Association.
Androgen Therapy for Low Sexual Desire: A Concerned Physician’s View James A. Simon, M.D. Clinical Professor George Washington University Washington, DC.
Slide source:
The Women’s Health Initiative Hormone Trials The Estrogen Only (women with a hysterectomy at baseline) and the Estrogen + Progestin (women with a uterus)
Slide Source: Lipids Online Slide Library Collaborative Atorvastatin Diabetes Study (CARDS) Type 2 diabetes mellitus Men and women.
A Randomized Placebo- Controlled Trial of Metformin for the Treatment of HIV Lipodystrophy Rakhi Kohli MD MS, Christine Wanke MD, Sherwood Gorbach MD,
ORIGIN Outcome Reduction with an Initial Glargine Intervention (ORIGIN) Trial Overview Large international randomized controlled trial in patients with.
Best first ? The ATAC completed treatment analysis Professor Jack Cuzick Wolfson Institute of Preventive Medicine, London, UK.
FDA Presentation ODAC Meeting July NDA Applicant: Eli Lilly Evista ® (Raloxifene Hydrochloride)
Laura Mucci, Pharm.D. Candidate Mercer University 2012 Preceptor: Dr. Rahimi February 2012.
WHI CT Sample Size, Outcomes, Follow-up Women, aged Total CT = 68,133 Diet Modification (DM) Trial Primary Outcomes: Breast & Colorectal Cancer Secondary.
The Prospective Pravastatin Pooling Project L I P I D CARECARE PPP Project Investigators Am J Cardiol 1995; 76:899–905.
WOSCOPS: West Of Scotland Coronary Prevention Study Purpose To determine whether pravastatin reduces combined incidence of nonfatal MI and death due to.
1Bachelot T et al. Proc SABCS 2010;Abstract S1-6.
Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 2 ARBITER-2 Trial Presented at The American Heart Association Scientific.
AA-2-1 Jerome D. Cohen, MD, FACC, FACP Professor of Internal Medicine / Cardiology Director, Preventive Cardiology Programs St. Louis University Health.
LIPID: Long-term Intervention with Pravastatin in Ischemic Disease Purpose To determine whether pravastatin will reduce coronary mortality and morbidity.
A Diabetes Outcome Progression Trial
Breast Cancer in the Women’s Health Initiative Trial of Estrogen Plus Progestin For the WHI Investigators Rowan T Chlebowski, MD., Ph.D.
02-15 INFC Substitution of raltegravir for ritonavir-boosted protease inhibitors in HIV-infected patients: The SPIRAL study* 1 Date of preparation:
MENAPOUSE. Natural Surgical premature RETROSPECTIVE Cessation of menstruation for 12 months In the absence of other physiological or psychological.
Menopausal Hormone Replacement Professor Gordana Prelevic, MD, DSc, FRCP Consultant Endocrinologist Royal Free Hampstead NHS Trust Whittington Health.
Anastrozole (‘Arimidex’): a new standard of care?
4S: Scandinavian Simvastatin Survival Study
Journal Club Alcohol, Other Drugs, and Health: Current Evidence November-December, 2015.
‘Arimidex’, Tamoxifen, Alone or in Combination (ATAC) trial: Completed Treatment Analysis.
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Care of the Transgender Patient Stephanie T. Page, MD, PhD Robert B. McMillen Professor in Lipid Research,
Rosuvastatin 10 mg n=2514 Placebo n= to 4 weeks Randomization 6weeks3 monthly Closing date 20 May 2007 Eligibility Optimal HF treatment instituted.
1 Risk Benefit and Conclusions George Sledge, MD Indiana University School of Medicine.
CCO Independent Conference Coverage*: The 2015 Annual Meeting of the CTRC-AACR San Antonio Breast Cancer Symposium, December 8-12, 2015 San Antonio, Texas.
Date of download: 6/2/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Menopausal Hormone Therapy and Health Outcomes During.
Double-blind, randomized trial in 4,162 patients with Acute Coronary Syndrome
CCO Independent Conference Coverage
Title slide.
Trial profile SAS denotes the Simvastatin in Aortic Stenosis Study
European Society of Cardiology 2017 Clinical Trial Update I
Alcohol, Other Drugs, and Health: Current Evidence
Pravastatin in Elderly Individuals at Risk of Vascular Disease
AIM HIGH Niacin plus Statin to prevent vascular events
HDL cholesterol and cardiovascular risk Epidemiological evidence
First time a CETP inhibitor shows reduction of serious CV events
TNT: Baseline and final LDL cholesterol levels
Current recommendations: what is the clinician to do?
WHAT’S NEW WITH THE TREATMENTS FOR HIGH-RISK DYSLIPIDEMIA?
Screening, Lipid Stabilization, and Placebo Run-in
Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis 
Trial profile Luc F Van Gaal, Lancet 2005;365:1389.
Original Article Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen Susan R. Davis, M.D., Ph.D., Michele Moreau, M.D., Robin Kroll,
Cardiovascular Disease in Women Module VI: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulators (SERMs) This slide set was.
The Heart Rhythm Society Meeting Presented by Dr. Johan De Sutter
PROSPER: trial design                                                                                                                                                                 
Presentation transcript:

11 Androgenic AEs by Maximum Free T P hase II and Phase III % of patients Placebo N= 703 TTS Upper Decile N=58 Acne710.3 Alopecia Facial Hair55.2 Voice Deepening 1.70 H20C

22 Effects of Testosterone in Rhesus Monkey Breast Tissue--Results Treatment (n)E (pg/mL)P (ng/mL)T (ng/mL)Ki67 (%) Control (5)< < E (4) < E/P (4) < E/T (5)  E/T was not different from control (p=0.07)  E/T was different from E (p =0.01) and E/P (p =0.005)  At roughly physiological levels, addition of testosterone reduced mammary tissue proliferation in OVX monkeys compared with estradiol alone; level is no different from control.  Flutamide administered to intact female monkeys for three months to suppress testosterone production doubled the proliferation rate. Dimitrakakis et al, Menopause 10 (4) (2003) S233

33 S Outcome by Age, y Coronary Heart Disease Stroke Venous Thromboembolism Invasive Breast Cancer Colorectal Cancer Hip Fracture Total Death Global Index CEE 16 (0.14) 87 (0.54) 74 (0.88) 19 (0.16) 79 (0.49) 60 (0.71) 18 (0.15) 49 (0.31) 34 (0.32) 25 (0.21) 42 (0.26) 27 (0.32) 8 (0.07) 26 (0.16) 27 (0.32) 5 (0.04) 6 (0.04) 27 (0.32) 34 (0.29) 127 (0.79) 130(1.54) 104 (0.89) 312 (1.95) 276 (3.28) Placebo 29 (0.24) 98 (0.59)) 72 (0.84) 19 (0.16) 50 (0.30) 49 (0.57) 15 (0.13) 39 (0.23) 24 (0.28) 35 (0.29) 60 (0.66) 29 (0.34) 14 (0.12) 31 (0.19) 13 (0.15) 1 (0.01) 19 (0.11) 44 (0.52) 47 (0.39) 131 (0.79) 111(1.30) 104 (0.89) 312 (1.95) 276 (3.28) 0.56 ( ) 0.92 ( )) 1.04 ( )) 1.08 ( ) 1.65 ( ) 1.25 ( ) 1.22 ( ) 1.31 ( ) 1.44 ( ) 0.72 ( ) 0.72 ( ) 0.94 ( ) 0.59 ( ) 0.88 ( ) 2.09 ( ) 5.04 ( ) 0.33 ( ) 0.62 ( ) 47 (0.39) 131 (0.79) 111(1.30) 104 (0.89) 312 (1.95) 276 (3.28) No. Cases Annualized (%) Hazard Ratio 95% CI) P-value for Interaction Favors CEE Favors Placebo Selected Clinical Outcomes by Participant Age and Randomization Assignment CEE=conjugated equine estrogen, CI=confidence interval

44 Multi-faceted Approach to Maximize Safe Use of Intrinsa Educational plans:  Package insert and patient information leaflet to promote safe use  Tools to help clinicians and patients diagnose/ recognize HSDD and identify appropriate patients  Web based education on the appropriate use of the product, prevalence and clinical implications of HSDD  CME programs supported by unrestricted grants W2C

55 Mean Change from Baseline in Efficacy Endpoints Satisfying Sexual Activity DesireDistress MCID>1>8.9< -20 Phase III TTS Patients Responders in Clinical Relevance Study C38

66 Sexuality After Hysterectomy with and without Oophorectomy Nathorst-Boos et al. J Psychosom Obstet Gynaecol 1993;14:283 * p<0.05 D7 ERT=Estrogen replacement therapy BSO w/ ERTBSO w/o ERTNo BSO Semi-structured Interview N=23N=25N=28 Libido same or better52%44%82%* Libido worse48%56%18%*

77 Power Considerations for Breast Cancer Assuming an event rate of 0.3%/year, alpha=0.05, one- sided test, with 15% disenrollment and 50% discontinuation, and 3 controls per Intrinsa user Year from launch RR Person years for Intrinsa Power % % % % % JAMA. 2004;291: LT3

88 Overlap of Free-T Between Low Libido and Normal Libido Women (SM Population Validation Studies) H36 Low LibidoNormal Libido Free Testosterone

99 Glucose (mg/dL) Change from Baseline SM 1 & SM 2 S49 PL (n=480) TTS (n=486) TTS 0-6 (n=855) TTS >6-12 (n=496) TTS >12-18 (n=132) Week 24 / Exit (a)Exposure to TTS (months) Change From Baseline

10 Insulin (  IU /mL) Change from Baseline SM 1 & SM 2 S50 Change From Baseline PL (n=469) TTS 0-6 (n=848) TTS >6-12 (n=354) Week 24 / Exit (a) TTS (n=481) Exposure to TTS (months)

11 Lipid Profile in NM 2 at 52 Weeks Excluding Patients Starting Antihyperlipidemics Post-Baseline* Triglycerides (mg/dL) Interim Data 1:2 Randomization LDL (mg/dL) HDL (mg/dL) Total Cholesterol (mg/dL) TTS N=234 PL N=108 Baseline/ Change from BL S108 * 7.7% Placebo vs 2.9% TTS

12 Carbohydrate Metabolism NM 1 & Placebo n=273 NM 1 TTS n=241 Placebo n=117 TTS n=276 Mean Baseline/  From Baseline Insulin (  IU/mL) HbA 1C (%) Glucose (mg/dL) NM 2 interim S120

13 Abuse is Impractical S19

14 Phase III Responders Compared to Women without HSDD Satisfying Sexual Activity/4 wks C32 Mean Score

15 Phase II Trial with Oral Estrogen  150 mcg/day testosterone not different from placebo  300 mcg/day testosterone safe and efficacious  450 mcg/day testosterone similar safety and no additional efficacy Sexual Desire Sexual Arousal Orgasm Sexual Pleasure Sexual Concerns Sexual Responsiveness Sexual Self Image Change from baseline Placebo 150mcg/d 300mcg/d 450mcg/d *p<0.05 * * E57 * Total Satisfying Activity

16 Time Course of Effect SM 1 & SM 2 E58 Week Sexual Desire Distress Total Satisfying Activity TTS Placebo * * * * * * * * * * * * * * p< 0.05

17 Insulin (  IU /mL) Change from Baseline SM 1 & SM 2 S50 Change From Baseline PL (n=469) TTS 0-6 (n=848) TTS >6-12 (n=354) Week 24 / Exit (a) TTS (n=481) Exposure to TTS (months)