This study evaluates whether L-Alanyl-L-Glutamine can reduce the incidence, extent and severity of adhesions after myomectomy. Half of the participants will receive L-Alanyl-L-Glutamine and the other half of participants will receive a saline placebo at the time of myomectomy.

The myriad medical and financial burdens of post-operative adhesions are well documented; however, treatment options are limited and controversial. Implantable physical barriers to prevent adhesions are commercially available, but most trials have failed to demonstrate compelling evidence to support widespread use. In recent years, advances have been made in our understanding of the cellular mechanisms underlying adhesiogenesis, raising the prospect of targeting these pathways to prevent post-surgical adhesions. However, to date, no drug has received regulatory approval for this purpose in any jurisdiction. Our study was designed to evaluate the efficacy and safety of a single intraoperative intraperitoneal dose of L-Alanyl-L-Glutamine (AG), an agent which has been shown to act upon key mediators in the adhesion formation pathway.

Methods: This was a randomized, double-blind, placebo-controlled study (DBRCT) of 47 women who underwent myomectomies by laparoscopy (N=37; AG-18 vs Placebo-19) or laparotomy (N=10; AG-5 vs Placebo-5) with a scheduled clinically necessary second-look laparoscopy (SLL) 6 - 8 weeks later. Digital recordings were obtained for all procedures. The primary endpoint was reduction in the incidence, severity and extent of post-operative adhesions, as analyzed by intention-to-treat (ITT) approach.

Three independent, blinded reviewers evaluated the operative video recordings to assess for presence of adhesions. Secondary endpoints assessed the safety and tolerability of AG. Post-hoc analysis assessed presence or absence of adhesions in the peritoneal cavity. Patients included those with previous history of surgery, endometriosis, and adhesiolysis was permitted at myomectomy.

Inclusion Criteria:

• Subjects are female
• Subjects are 18 years of age or older at the time of consent
• Subjects have a BMI between 17-40
• Subjects must have signed informed consent form
• Subjects have a preoperative diagnosis of uterine fibroids and plan to have a myomectomy completed surgically as part of their standard of care
• Subjects must have a physical examination and compliance assessment

Exclusion Criteria:

• Subjects whose BMI is outside the range of 17-40
• Subjects participating in another clinical trial with a drug or device
• Subjects who have participated in a clinical trial with a drug or device within 30 days prior to this study
• Subjects with suspected or diagnosed pregnancy
• Subjects with suspected intraabdominal infection
• Subjects who are immunocompromised
• Subjects diagnosed with cancer
• Subjects treated with hemostatic agents (e.g. fibrin sealant, collagen, oxidized cellulose)
• Subjects treated with adhesion prevention agents other than the Anti-Adhesion product (APP) (e.g. Intergel ® Adhesion Prevention Solution, Seprafilm ® Membrane)
• Subjects taking anti-epileptic medication
• Subjects who have been treated with Methotrexate or other chemotherapeutics agents
• Subjects with an American Fertility Society score of Stage D at the time of myomectomy as determined by the surgeon
• Positive viral serology screening results for hepatitis B surface antigen, antibodies to hepatitis C virus or human immunodeficiency

Adverse events were monitored for 8 weeks post-myomectomy.

Safety was assessed though the incidence of adverse drug events (AE) and clinical lab abnormalities. The laparotomy arms were included for safety analysis, and laboratory assessments were conducted at the time of myomectomy and at SLL for all patients that enrolled and completed the study.

There were no limitations and caveats to the trial that would impact the integrity, analysis or interpretation of the trial results. Dropouts were accounted for in the study design and those excluded did not impact the statistics and/or the power of the trial.