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The study was prematurely terminated due to the results of the interim analysis conducted, as outlined in the initial project plan.
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The objective of this work is to conduct a randomized, double-blind, placebo-controlled clinical trial to assess the efficacy and safety of cannabis extract in women with endometriosis who have already undergone hormonal contraceptive treatment and surgery without satisfactory response.
The Dreamland study is a two-arm, parallel-group, individually randomized (1:1 allocation ratio), controlled by disease stage, participant and investigator blinded, single-site superiority trial of oral cannabis extract (CBD). CBD will be given orally starting at 10 mg daily and up-titrated to a maximum dose of 150 mg daily. Dose up-titration will be based on clinical response or side effects, whichever comes first. After 63 days of treatment, gradual withdrawal will be performed during one week. Then, at 70 days, there will be an open-label extension wherein all participants from control group will be offered a course of CBD according to the same previous protocol.
This research intends to :
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cannabis Derivatives | Experimental | Cannabis Derivatives (98% CBD, 2% THC) will be given orally starting at 10 mg daily and up-titrated to a maximum dose of 150 mg daily. Dose up-titration will be based on clinical response or side effects, whichever comes first. After 63 days of treatment, gradual withdrawal will be performed during one week. All patients will take hormonal contraceptives, preferably progestagen-only. All participants will perform invasive and non-invasive procedures with the nursing team. The invasive will be blood collections, to evaluate laboratory parameters. The non-invasive ones refer to the measurement of height, weight, body temperature, and sleep pattern, as will pain threshold. In addition, they will be monitored through weekly self-assessment scales, applied remotely, electronically (cell phones or computers), with an estimated duration of ten minutes each, which will have their responses recorded in an electronic database, by the study coordination team. |
|
| Placebo | Placebo Comparator | Placebo will be given at the same protocol described before. The bottle, label, color and density of the contents will be the same. All patients will take hormonal contraceptives, preferably progestagen-only. Then, at 70 days, there will be an open-label extension wherein all participants from control group will be offered a course of active treatment according to the same previous protocol. All participants will perform invasive and non-invasive procedures with the nursing team. The invasive will be blood collections, to evaluate laboratory parameters. The non-invasive ones refer to the measurement of height, weight, body temperature, and sleep pattern, as will pain threshold. In addition, they will be monitored through weekly self-assessment scales, applied remotely, electronically (cell phones or computers), with an estimated duration of ten minutes each, which will have their responses recorded in an electronic database, by the study coordination team. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cannabis Derivatives | Drug | CBD 10 mg (up-titrated until 150mg or adverse effects) daily for 9 weeks |
|
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients with pain change of 30% | Proportion of women with at least 30% of change in pain intensity. Pain intensity measured through visual analogue scale. | Time points for assess: Week 1, Week 3, Week 4, Week 5, Week 7, Week 8, Week 9; Data will be reported through study completion, an average of 1 year |
| Proportion of patients with pain change of 50% | Proportion of women with at least 50% of change in pain intensity. Pain intensity measured through visual analogue scale. | Time points for assess: Week 1, Week 3, Week 4, Week 5, Week 7, Week 8, Week 9; Data will be reported through study completion, an average of 1 year |
| Quantitative change in pain intensity | Absolute variation of pain intensity measured through visual analogue scale | Time points for assess: Week 1, Week 3, Week 4, Week 5, Week 7, Week 8, Week 9; Data will be reported through study completion, an average of 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Pain threshold change | Changes in the thermal peripheral pain thresholds: the range of temperatures at which a participant begins to perceive heat as painful: comparison between the beginning (day 0) and the end of the protocol (day 63). | Day 0, Day 63 |
| Central sensitization change |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center of Chronic Pelvic Pain and Gynecologic Endoscopy of Ribeirao Preto Medical School, University of Sao Paulo | Ribeirão Preto | São Paulo | 14049-900 | Brazil |
All of the individual participant data collected during the trial, after deidentification
Immediately the following publication. No end date
Researchers who provide a methodologically sound proposal. Depending on the level of the proposed use of data, approval by an independent review committee will be required for the identified purpose.
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| ID | Term |
|---|---|
| D004715 | Endometriosis |
| D017699 | Pelvic Pain |
| D002189 | Marijuana Abuse |
| ID | Term |
|---|---|
| D005831 | Genital Diseases, Female |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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| ID | Term |
|---|---|
| D000080066 | Contraceptive Agents, Hormonal |
| ID | Term |
|---|---|
| D003270 | Contraceptive Agents |
| D012102 | Reproductive Control Agents |
| D045505 | Physiological Effects of Drugs |
| D020228 | Pharmacologic Actions |
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Volunteers, administrative staff, laboratory technicians, doctors who will carry out the assessments, and statisticians will be blind to the treatment group and will not know about the group treatment information.
| Placebo | Drug | Placebo 10 mg (up-titrated until 150mg or adverse effects) daily for 9 weeks |
|
| Hormonal Contraceptive Agents | Drug | All participants will be given hormonal contraceptive. |
|
Changes in the score from Central Sensitization Inventory between the beginning (day 0) and the end of the protocol (day 63). Total scores ranging from 0-100. Higher scores mean a worse outcome. Score higher than 40 suggest central sensitization. |
| Day 0, Day 63 |
| Brief measure for assessing generalized anxiety disorder | Changes in the score from Generalized Anxiety Disorder (GAD7) scale between the beginning (day 0) and the end of the protocol (day 63). Total scores ranging from 0-21. Higher scores mean a worse outcome. Scores higher than 10 suggest generalized anxiety disorder. | Day 0, Day 63 |
| Measure of the degree of depression severity | Changes of scores for depressive symptoms over time during the study period (day 0-63) using Patient ́s Health Questionnaire-9 (PHQ-9). Total scores ranging from 0-27. Higher scores mean a worse outcome. Scores less than or equal to 4 suggest minimal depression. | Day 0, Day 63 |
| Alanine aminotransferase (ALT) | Change in ALT concentration in plasma | Week 0, Week 1, Week 5, Week 9. |
| Aspartate aminotransferase (AST) | Change in AST concentration in plasma | Week 0, Week 1, Week 5, Week 9. |
| Glucose | Change in glucose concentration (glycemia) in plasma | Week 0, Week 1, Week 5, Week 9. |
| Bilirubin | Change in bilirubin concentration in plasma | Week 0, Week 1, Week 5, Week 9. |
| Cannabidiol (CBD) | Change in CBD concentration in plasma | Week 0, Week 1, Week 5, Week 9. |
| Tetrahydrocannabinol (THC) | Change in THC concentration in plasma | Week 0, Week 1, Week 5, Week 9. |
| Side effects | Occurrence of side effects over time during the study period (day 0-63) | Week 0, Week 1 (Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, Day 7), Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8, Week 9. Participants will be able to establish contact with a team doctor especially to report side effects. |
| D000091662 | Genital Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019966 | Substance-Related Disorders |
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
| D020164 | Chemical Actions and Uses |
| D045506 | Therapeutic Uses |