The effect of therapeutic and supratherapeutic oral doses of nomegestrol acetate (NOMAC)/17β-estradiol (E2) on QTcF intervals in healthy women: results from a randomized, double-blind, placebo- and positive-controlled trial.
OBJECTIVE
Nomegestrol acetate (NOMAC)/17β-estradiol (E2) is a monophasic oral contraceptive that contains a progesterone-derived progestogen (NOMAC), and E2, a bio-identical estrogen. The primary objective of this thorough QT/QTc study was to investigate whether once-daily administration of therapeutic (2.5/1.5 mg) and supratherapeutic (12.5/7.5 mg) doses of NOMAC/E2 were associated with prolongation of the mean Fridericia-corrected QT (QTcF) interval in electrocardiograms at steady-state concentrations of NOMAC/E2 versus placebo. The co-primary objective was to establish assay sensitivity after a single dose of moxifloxacin (positive control).


METHODS
This was a randomized, double-blind, parallel-group trial comparing 2.5/1.5 mg of NOMAC/E2 (therapeutic dose), 12.5/7.5 mg of NOMAC/E2 (supratherapeutic dose), placebo, and moxifloxacin 400 mg. Double-blind study medication was administered from day -1 to 14. Healthy women aged 18-50 years were randomized.


RESULTS
The largest time-matched mean QTcF difference compared with placebo for the therapeutic dose of NOMAC/E2 was 1.6 ms, with an upper limit (UL) of a one-sided 95% confidence interval (CI) of 5.2 ms, and 3.1 ms with an UL 95% CI of 7.0 ms for the supratherapeutic dose. The UL for the time-matched QTcF differences compared with placebo were below the 10 ms threshold defined in the ICH E14 guideline for all time points, both for the therapeutic and the supratherapeutic dose. For moxifloxacin, assay sensitivity was demonstrated.


CONCLUSIONS
This thorough QT/QTc study showed that therapeutic and supratherapeutic doses of NOMAC/E2 were not associated with clinically relevant QTc interval prolongation in healthy women after a 2-week period of dosing.
Clinical Research, MSD Pharma, 8 Biomedical Grove, #04-01/05, Neuros Building, Biopolis, 138665, Singapore, Singapore, pieter-jan.de.kam@merck.com.
Pieter-Jan
PJ
de Kam
Jacqueline
J
van Kuijk
Otilia
O
Lillin
Teun
T
Post
Torben
T
Thomsen
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced*; D008535:Megestrol / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D000077266:Moxifloxacin; D009649:Norpregnadienes / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D055815:Young Adult
D003277:Contraceptives, Oral, Combined; D024841:Fluoroquinolones; D009649:Norpregnadienes; D004958:Estradiol; C038501:nomegestrol acetate; D008535:Megestrol; D000077266:Moxifloxacin