Juveena Hydrogel System for Asherman's Syndrome

Recruiting at 15 trial locations

Overseen By Jonathan Bissett

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Waitlist Available

Sponsor: Rejoni Inc.

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial is testing if Juveena hydrogel can safely and effectively reduce scar tissue formation in women who have had certain types of uterine surgeries. The gel is applied inside the uterus to prevent the walls from sticking together during healing.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, you cannot use systemic corticosteroids within 1 week of the study procedure or have long-acting injectable hormones that would still be active at the time of the procedure.

What data supports the idea that Juveena Hydrogel System for Asherman's Syndrome is an effective treatment?

The available research shows that hyaluronic acid gel, which is similar to Juveena Hydrogel, is effective in preventing the reformation of adhesions after surgery for Asherman's Syndrome. This suggests that Juveena Hydrogel could also be effective in treating the condition. Compared to other treatments like intrauterine balloons and contraceptive devices, hyaluronic acid gel has been shown to be beneficial in preventing adhesions, which supports the effectiveness of Juveena Hydrogel. ^{1 2 3 4 5}

What safety data is available for the Juveena Hydrogel System for Asherman's Syndrome?

The provided research does not contain any specific safety data for the Juveena Hydrogel System or its variants. The studies focus on other medical devices and treatments, such as vaginal mesh implants, levonorgestrel intrauterine systems, and vaginal energy-based devices, none of which are related to the Juveena Hydrogel System. ^{6 7 8 9 10}

Is the Juveena Hydrogel System a promising treatment for Asherman's Syndrome?

Yes, the Juveena Hydrogel System is a promising treatment for Asherman's Syndrome. It uses hydrogels, which are special gels that can deliver healing substances directly to the damaged area in the uterus. This helps in repairing the tissue and improving fertility. The system can also release these substances slowly over time, making the treatment more effective. ^{3 11 12 13 14}

Research Team

Ian Feldberg

Principal Investigator

Rejoni Inc.

Eligibility Criteria

This trial is for premenopausal women at high risk of developing intrauterine adhesions, such as those needing hysteroscopic procedures like adhesiolysis or myomectomy. Participants must agree to avoid hormonal contraception and IUDs, not be pregnant or breastfeeding, have no history of certain cancers or infections, and commit to study requirements.

Inclusion Criteria

Subject agrees to all protocol requirements including returning for specified visits within intervals identified within this protocol.

I agree not to use hormonal birth control or IUDs until after Week 8 of the study.

Subject has signed the IRB/EC approved informed consent

Exclusion Criteria

I have had surgery inside my uterus within the last 2 months.

Pregnant (positive pregnancy test) or lactating.

I have not taken any corticosteroids in the last week.

Treatment Details

Interventions

• Juveena Hydrogel System (Hydrogel System)

Trial Overview The study tests if the Juveena Hydrogel System can prevent scarring inside the uterus after a procedure that could cause these adhesions. Women will either receive this new hydrogel treatment along with their surgery (TCGP + Juveena) or just the surgery alone to compare outcomes.

Participant Groups

Group I: Transcervical Gynecological Procedure + Juveena Hydrogel Experimental Treatment 1 Intervention

Transcervical Gynecological Procedure + Juveena Hydrogel

Group II: Transcervical Gynecological Procedure alone (standard of care) Active Control 1 Intervention

Transcervical Gynecological Procedure alone (standard of care)

Who Is Running the Clinical Trial?

Rejoni Inc.

Lead Sponsor

Trials

3

Recruited

190+

Findings from Research

Asherman's syndrome, a condition caused by intrauterine adhesions, often requires repeated surgeries due to high rates of adhesion recurrence, highlighting the importance of secondary prevention strategies.

Current secondary prevention methods, including second-look hysteroscopy, hormonal treatments, and barrier techniques, show varying efficacy, but combining barriers with hormonal support for endometrial regeneration appears to be the most promising approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevention of de novo adhesion formation in patients with Asherman's syndrome. BarboraBoudová, Barbora., Lisá, Zdeňka., Richtárová, Adéla., et al.[2021]

Intrauterine infusion of autologous platelet-rich plasma (PRP) was well tolerated by patients with moderate-severe Asherman syndrome (AS), showing no adverse effects during the procedure.

However, the study found no significant improvements in endometrial thickness or pregnancy rates when comparing PRP infusion to saline control, indicating that while PRP is a safe option, its efficacy in enhancing fertility outcomes in AS patients remains uncertain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Autologous platelet-rich plasma treatment for moderate-severe Asherman syndrome: the first experience. Aghajanova, L., Sundaram, V., Kao, CN., et al.[2022]

In a study of 107 women with Asherman's syndrome, both the intrauterine balloon and intrauterine contraceptive device (IUD) significantly reduced adhesion reformation after hysteroscopic adhesiolysis compared to hyaluronic acid gel and control groups.

The intrauterine balloon was found to be more effective than the IUD in preventing adhesion reformation, highlighting the superiority of mechanical methods over the gel treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study. Lin, X., Wei, M., Li, TC., et al.[2022]

The study evaluated 20 patients with Asherman syndrome treated in an outpatient hysteroscopy clinic, showing that 84% had no or mild adhesions after treatment, indicating a high success rate for outpatient management.

All patients reported normal menstrual cycles post-treatment, and 6 patients achieved spontaneous pregnancies, with 5 resulting in term deliveries, demonstrating the efficacy of outpatient hysteroscopic adhesiolysis without the need for general anesthesia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of Asherman's syndrome in an outpatient hysteroscopy setting. Bougie, O., Lortie, K., Shenassa, H., et al.[2022]

In a study involving 272 patients with moderate-to-severe intrauterine adhesions, the use of auto-cross-linked hyaluronic acid gel after hysteroscopic adhesiolysis did not significantly reduce the recurrence of intrauterine adhesions compared to standard care alone.

There were no notable differences in the improvement of menstrual patterns or AFS scores between the treatment group and the control group, indicating that the gel did not provide additional benefits in recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Auto-Cross-Linked Hyaluronic Acid Gel for Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis: A Randomized Controlled Trial. Zhou, Q., Shi, X., Saravelos, S., et al.[2021]

A user-testing study involving 13 participants, including women with experience of vaginal mesh implants, found that a newly developed patient resource on complications was generally clear and helpful, enhancing usability with features like easy-to-read fonts and simple language.

The study emphasized the importance of health professionals in guiding patients through the resource, which could improve understanding and interpretation of the information provided.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

User testing a patient information resource about potential complications of vaginally inserted synthetic mesh. Angelova, N., Taylor, L., McKee, L., et al.[2021]

In a study of 216 women using the levonorgestrel-releasing intrauterine system (LNG-IUS) for heavy menstrual bleeding, 39.5% opted for a second device after the initial 5-year period, indicating good long-term acceptability.

The main reason for early removal of the LNG-IUS was menopause, with 47.1% of early removals attributed to this, suggesting that the device is effective and well-tolerated until menopause occurs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability of the levonorgestrel intrauterine system in the long-term treatment of heavy menstrual bleeding: how many women choose to use a second device? Lete, I., del Carme Cuesta, M., Marín, JM., et al.[2013]

In a study of 201 women, both pubovaginal sling (PVS) and synthetic midurethral sling (MUS) procedures showed similar efficacy in treating urinary incontinence, with cure rates of 75.8% for PVS and 80.9% for MUS after a median follow-up of 13.8 months.

Complication rates and voiding difficulties were comparable between the two groups, suggesting that PVS can be a safe alternative for patients concerned about mesh implantation associated with MUS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contemporary comparison between retropubic midurethral sling and autologous pubovaginal sling for stress urinary incontinence after the FDA advisory notification. Mock, S., Angelle, J., Reynolds, WS., et al.[2015]

The media coverage in France in 2017 significantly increased the reporting of adverse events (AEs) related to the Mirena intrauterine device, with reports rising from 510 (15.8%) before the media peak to 2714 (84.2%) after.

After the media coverage, reports predominantly came from patients (98.6%) rather than health professionals, and highlighted new concerns such as anxio-depressive disorders and sexual disorders, indicating a shift in the perception of Mirena's safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events reported for Mirena levonorgestrel-releasing intrauterine device in France and impact of media coverage. Langlade, C., Gouverneur, A., Bosco-Lévy, P., et al.[2021]

A review of 42 medical device reports on vaginal energy-based devices revealed that most patient complaints, including vaginal pain and urinary symptoms, were not severe, with serious adverse events being rare (only 3.5% reported third-degree burns).

The majority of complaints were reported after the FDA's July 30, 2018 warning, suggesting that increased awareness and potential litigation may have influenced reporting rates, highlighting the need for further research on the safety and efficacy of these devices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vaginal energy-based devices: characterization of adverse events based on the last decade of MAUDE safety reports. Wallace, SL., Sokol, ER., Enemchukwu, EA.[2021]

A decellularized endometrial hydrogel (EndoECM) was shown to promote significant endometrial regeneration and fertility restoration in a mouse model, particularly when supplemented with growth factors, leading to increased gland numbers, cell proliferation, and new blood vessel formation.

The study suggests that EndoECM hydrogels could be a promising treatment for endometrial conditions like Asherman's syndrome and endometrial atrophy, which currently lack effective therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bioengineered endometrial hydrogels with growth factors promote tissue regeneration and restore fertility in murine models. López-Martínez, S., Rodríguez-Eguren, A., de Miguel-Gómez, L., et al.[2021]

Hydrogels are emerging as a promising treatment for intrauterine adhesions (IUAs) by encapsulating therapeutic agents like estrogen and cytokines, which can help in the repair of the endometrial lining.

These hydrogels not only deliver medication effectively but also serve as a temporary barrier that degrades naturally in the body, minimizing the risk of infection associated with additional surgeries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hydrogel, a novel therapeutic and delivery strategy, in the treatment of intrauterine adhesions. Lv, H., Wu, B., Song, J., et al.[2022]

The E2-HP hydrogel, which encapsulates 17β-estradiol, demonstrated a sustained release and significantly improved endometrium regeneration in a rat model of intrauterine adhesions (IUA), indicating its potential as an effective treatment.

The therapeutic effects of the E2-HP hydrogel were linked to the suppression of endoplasmic reticulum (ER) stress signals, suggesting that targeting ER stress could be a promising strategy for treating IUA in women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model. Zhang, SS., Xia, WT., Xu, J., et al.[2018]

Mesenchymal stem cell-secretome (MSC-Sec) offers a safer alternative to live stem cell therapies for treating endometrial injuries and preventing Asherman's syndrome, as it has a superior safety profile and can be stored without losing effectiveness.

The study demonstrates that a new treatment using crosslinked hyaluronic acid gel loaded with MSC-Sec can effectively repair endometrial injuries in rats and promote viable pregnancies, indicating its potential for clinical application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hyaluronic Acid Hydrogel Integrated with Mesenchymal Stem Cell-Secretome to Treat Endometrial Injury in a Rat Model of Asherman's Syndrome. Liu, F., Hu, S., Yang, H., et al.[2023]

References

1. Czech Republic pubmed.ncbi.nlm.nih.gov

Prevention of de novo adhesion formation in patients with Asherman's syndrome. [2021]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Autologous platelet-rich plasma treatment for moderate-severe Asherman syndrome: the first experience. [2022]

3. Ireland pubmed.ncbi.nlm.nih.gov

A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Treatment of Asherman's syndrome in an outpatient hysteroscopy setting. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Auto-Cross-Linked Hyaluronic Acid Gel for Prevention of Intrauterine Adhesions after Hysteroscopic Adhesiolysis: A Randomized Controlled Trial. [2021]

6. England pubmed.ncbi.nlm.nih.gov

User testing a patient information resource about potential complications of vaginally inserted synthetic mesh. [2021]

7. Ireland pubmed.ncbi.nlm.nih.gov

Acceptability of the levonorgestrel intrauterine system in the long-term treatment of heavy menstrual bleeding: how many women choose to use a second device? [2013]

8. United States pubmed.ncbi.nlm.nih.gov

Contemporary comparison between retropubic midurethral sling and autologous pubovaginal sling for stress urinary incontinence after the FDA advisory notification. [2015]

9. England pubmed.ncbi.nlm.nih.gov

Adverse events reported for Mirena levonorgestrel-releasing intrauterine device in France and impact of media coverage. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Vaginal energy-based devices: characterization of adverse events based on the last decade of MAUDE safety reports. [2021]

11. England pubmed.ncbi.nlm.nih.gov

Bioengineered endometrial hydrogels with growth factors promote tissue regeneration and restore fertility in murine models. [2021]

12. England pubmed.ncbi.nlm.nih.gov

Hydrogel, a novel therapeutic and delivery strategy, in the treatment of intrauterine adhesions. [2022]

13. New Zealand pubmed.ncbi.nlm.nih.gov

Three-dimensional structure micelles of heparin-poloxamer improve the therapeutic effect of 17β-estradiol on endometrial regeneration for intrauterine adhesions in a rat model. [2018]

14. Germany pubmed.ncbi.nlm.nih.gov

Hyaluronic Acid Hydrogel Integrated with Mesenchymal Stem Cell-Secretome to Treat Endometrial Injury in a Rat Model of Asherman's Syndrome. [2023]