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Clinical trial with subdermal implants containing norgestrienone.

Norgestrienone implants delivering approximately 225 microgram/ day were tested clinically for contraceptive effectiveness and acceptability in 145 women. Five pregnancies occurred in 2259 woman-months of use, one in the 11th month, one in the 15th and three in the 16th month of use. Continuation rate at 12 months was 86.7. The number of bleeding runs and bleeding days was increased in approximately 12% of the subjects. Ten percent of the patients had no bleeding in the first 90 days of treatment. Changes in bleeding pattern led to closures in four cases. Headache and signs of mild androgenicity were among the leading side effects. Blood and urine analysis throughout the study showed normal values of 17 different parameters, but a tendency to lower cholesterolemia not associated with changes in thyroid hormone levels, was observed in several patients. Cortisol was found slightly under the lower normal range in one subject without clinical manifestations of hypoadrenalism. It is concluded that norgestrienone implants should be replaced every twelve months for maximal contraceptive effect and because of their efficacy and good acceptability, evaluation of their long term use is warranted.

Adolescent

Radioimmunoassays of ethinyl-norgestrienone (R-2323) and medroxyprogesterone acetate (MPA) and their clinical applicability.

Radioimmunoassays for 2 synthetic progestins (Ethinyl-norgestrienone, R 2323 and medroxyprogesterone acetate, MPA) are demonstrated. 10 patients aged 31 to 72 years were treated with ethinyl-norgestrienone with different schedules and 3 men suffering from benign prostatic hypertrophy were treated with medroxygesterone acetate. Plasma levels of testosterone, LH, FSH were monitored before, during and after treatment.

Adult

Intravaginal contraception with the synthetic progestin, R2010.

Four women used polysiloxane vaginal rings of core design containing 50 mg of norgestrienone (17 alpha-ethynyl-17 beta-hydroxy-estra-4,9,11,trien-3-one). The treatment was given in three-week cycles, leaving one treatment-free week between the cycles. The patterns of bleeding were registered and plasma norgestrienone (R2010), estradiol, progesterone, and gonadotropins were determined. Altogether twelve cycles were studied. The patterns of bleeding were unsatisfactory; only one subject had regular bleedings, and two of these were preceded by a luteal phase. The mean plasma concentration of norgestrienone (R2010) produced by the rings was 0.9 ng/ml. Ovulation was observed in 25% of cycles studied. Some follicular activity was present in every subject as judged by estradiol peaks. Excluding LH peaks in subjects who ovulated, mild pituitary suppression was achieved by this treatment. The only side-effect complained of was acne in one subject. The ring was regarded as easy to use.

Adult

The effect of a synthetic progestine on the fine structure of the epididymal head (stereological analysis).

The alterations induced in principal cells of the epididymal head tissue of the rat by administration of a synthetic progestine (R2323, ethinyl-norgestrienone) were studied by electron microscopy. A total of 3 male, sex mature rats was applicated ethinyl-norgestrienone during a 3 months period in low dosage (60 mug) per day and was studied with 5 control animals. Stereological methods devised by Weibel (1969) and Rohr et al. (1976) were applied to light and electron micrographs. The calculated values are related to 1 cm3 of epididymal tissue, 1 cm3 of epididymal cell and 1 cm3 of epididymal cell cytoplasm. The Golgi apparatus was further subdivided; the values for the Golgi compartments are therefore refered to 1 cm3 of Golgi apparatus was further subdivided; the values for the Golgi compartments are therefore refered to 1 cm3 of Golgi apparatus. In the treated animals there was, related to the unit of epididymal tissue, a significant decrease in the volume density of the interductular tissue, whereas that for the lumina was significantly higher. The volume density of the glandular epithelium remains unchanged. Refered to the unit volume of principal cell cytoplasm the rough endoplasmic reticulum shows a signficant decrease by 6.5%, whereas the smooth endoplasmic retiuclum is increased by 6.3%. The volume density of the lysosomes was calculated to be 4.3% (Control 2.5%). The stereological data of the Golgi apparatus indicate a vacuolar transformation: Increased volume of vacuoles, decreased volume fraction of saccules and vesicles. However, the volume density of the whole Golgi apparatus remains unchanged. An impaired secretory activity of the principal cells could be assumed.

Animals

Contraception with long acting subdermal implants: I. An effective and acceptable modality in international clinical trials.

This paper presents results of a double blind, multi-centered and multi-national study of two progestin only subdermal implants used for contraception. A regimen of six capsules of levonorgestrel (Ng) used by 492 women had a net cumulative 12-month pregnancy rate of 0.6 percent and a continuation rate of 74.6 percent. 498 women used six capsules of norgestrienone (R2010) and experienced a net cumulative 12-month pregnancy rate of 3.5 percent and a continuation rate of 79.4 percent. The difference in the pregnancy rate was significant at P less than 0.01, while there was no significant difference in the continuation rates. Menstrual problems were the principal reason for termination of the levonorgestrel regimen, accounting for approximately half of all terminations. There were significantly fewer menstrual problems among users of the norgestrienone (R2010) capsules; the net cumulative 12-month termination rate for this reason was 4.3 percent. Results are compared with continuation and termination rates for acceptors of the Copper T 200 at the same clinics. The low pregnancy rate and reasonably high continuation rate of the norgestrel implants coupled with the fact that the expected effective lifetime of a set of capsules is of the order of 3-5 years appears to warrant further development of this contraceptive regimen.

Adolescent

Long acting contraceptive implants. An analysis of menstrual bleeding patterns.

The menstrual patterns of women using subdermal implants of levonorgestrel and norgestrienone included in a double-blind clinical trial was evaluated by the method developed by the International Committee on Contraception Research. Women using Copper T200 randomly selected in the same clinics were used as controls. Both implant regimens were associated with a high frequency of reduced bleeding and norgestrel patients had also a high proportion of increased and irregular bleeding. Termination of use was associated to increased bleeding but not so much to reduced bleeding.

Adolescent

Release of contraceptive steroids from sustained release dosage forms and resulting plasma levels.

The correlations of plasma levels of levonorgestrel, megestrol acetate and norgestrienone with the doses delivered from subdermal implants and contraceptive rings have been examined. Differences in plasma levels as large as three-fold between different subjects receiving nearly identical doses were observed with all three steroids. The relative plasma levels seen from one subject to another showed high consistency over time. Part of the explanation may lie in differing levels of sex hormone binding globulin, but additional factors must be operative since megestrol acetate binds only weakly with this carrier.

Contraceptive Devices, Female

Clinical chemistry in women treated with progestogen implants.

Effects on metabolic parameters of six subdermal implants of d-norgestrel, norgestrienone (R2010) and methylnorgestrienone (R2323) were studied in women. In general, tests remained within the normal range. An exception was increases in serum transaminase levels in several subjects on R2323 implants. Average cortisol values showed a tendency to decrease on all three regimens, but remained within the significance only with R2323 at six months and R2010 at 12 months. Serum cholesterol levels showed significant decreases on R2010 implants.

Cholesterol

Steroidal compounds (injectable and implants) affecting spermatogenesis in men.

The effect of androgen and different progestins on spermatogenesis was studied in young men with subfertility, prostatovesiculitis and haematospermia, and in older men with benign hypertrophy of the prostate. The compounds (testosterone, testosterone oenanthate, ethinyl oestradiol, megestrol acetate, ethinyl norgestrienone and Depo-Provera) were administered intramuscularly, orally or as subcutaneous silastic implants.

Adult

Clinical experience with implant contraception.

Subdermal implants of polysiloxane (Silastic) capsules containing a number of synthetic progestagens have been studied in clinical trials to determine their contraceptive effectiveness and acceptability. The steroids studied include norgestrienone (R2010), gestrigone (R2323), megestrol acetate, d-norgestrel, norethindrone, ST-1435, lynestrenol and R-1364. With some of these steroids, studies have been undertaken with a varying number of implanted capsules. The estimated duration of use varies from 6 months to 6 years depending on dose and release rate of the individual steroid. The results of these studies involving about 5000 women in 8 years, indicate in general a high rate of effectiveness, as well as acceptability. Continuation rates at one year were generally 80% or greater. Abnormal bleeding patterns are the major disadvantage. Studies with implatns containing a combination of estrogen and progestogen are being undertaken in an attempt to improve the bleeding pattern.

Contraceptive Agents, Female

Ultrastructural stereology: a new approach to the study of prostatic function.

Stereology is a method used to obtain quantitative information of structural changes at the light and electron microscopic level. The basic principles of stereology are outlined below. This paper shows how stereologic techniques can be used to obtain structural data from histologic and electron micrographs of intact tissue and cells. A morphometric model, which provides information on the structure of the prostatic gland has been developed for the rat prostate. The model consists of morphologically defined space and membrane compartments of the prostatic gland and the glandular cells. The alterations, induced in the glandular cells of the ventral lobe of rat prostate by the administration of a synthetic progestin (ethinyl-norgestrienone), were studied by electron microscopy. The results presented are relative to a cubic centimeter of prostatic tissue, a cubic centimeter of acinar parenchyma, and glandular cell cytoplasm. An attempt to relate stereologic and biochemical data is shown.

Animals

Stereology, a new quantitative morphological approach to study prostatic function and disease.

Although a considerable amount of quantitative biochemical data of the prostatic gland is available the current morphological information is restricted up to now to descriptive findings. Stereology is the application of mathematical axioms and allows one to quantitate three-dimensional structures from the measurement of two-dimensional cross sections thereof. The stereological techniques provide values for volumes, surfaces and number of tissue and glandular cellular components found within the prostatic gland. Four examples are presented to illustrate how quantitative morphology can be applied to study prostatic function and disease. A stereological model, which provides information on the structure of the prostatic gland is shown for the rat prostate (ventral lobe). The model consists of morphologically defined space and membrane components of the prostatic gland and the glandular cell. The alteration, induced in the glandular cells of the ventral lobe of the rat prostate by administration of a synthetic progestine (ethinyl-norgestrienone) were studied by stereological methods. An attempt was made to quantify the morphological aspects of both, the epithelial and stromal components of the normal human prostate (3rd decade of life) and of benign prostatic hyperplasia. In comparing the stereological data of the glandular prostatic cell in the normal human prostate with that in benign prostatic hyperplasia, a diminished secretory activity of the glandular cell in benign prostatic hyperplasia is indicated. A high volume density of the fibromuscular tissue, as well as an activation of the smooth muscle cell in the fibromuscular tissue is observed in benign prostatic hyperplasia.

Adult

[Radioimmunoassay of synthetic steroids].

The sensitivity of a radioimmunoassay depends on the intrinsic association constant of the interaction between ligand and antibody. Its specificity depends on the position of the chain which forms the link with the antigen. Thus, an antibody specific of estradiol has been obtained by coupling estradiol to albumin via a chain at position 7. For synthetic steroids the structure of which is sufficiency different from that of natural hormones, the requirements for a sensitive assay method not involving chromatography are simply maximum affinity and positioning of the couple at a site which does not undergo metabolic attack. These criteria were used to develop assays for R 2858 and R 2453 which obviate the need to administer radioactive product in clinical pharmacology. Cross-reaction with structural analogs may be used to assay competitors. Thus, R 2323 antibody, highly specific for endogenous steroids, may be used to assay other trienes such as R 1697 (trenbolone) and R 2010 (norgestrienone).

Antibody Specificity

Action of midcycle contraceptive (R 2323) on the human endometrium.

Over 2,148 cycles of midcycle oral administration of R 2323 (50 mg. per day on Days 15,16, and 17), the authors recorded a drug-failure pregnancy rate of 5 per cent and an unusually regular cycle length of 28 +/- 2 days. During this trial, endometrial biopsies obtained in the luteal phase were examined by light and electron microscopy and compared to pretreatment biopsies. Light microscopy indicated a weakly secretory endometrium suggestive of some, albeit low, progesterone impregnation. Ultrastructural examination revealed deleterious changes in the development of the nucleolar channel system and giant mitochondria and a delay in the migration of glycogen granules. This low progesterone impregnation could be explained either by a direct effect of R 2323 on cell ultrastructure or by interference with progesterone availability. It would appear that R 2323 acts as a temporary substitute for progesterone at the receptor level but that it does not induce all the biological manifestations of this hormone, in particular, the endometrial changes required for implantation.

Biopsy