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Trial registered on ANZCTR
Registration number
ACTRN12617001317381
Ethics application status
Approved
Date submitted
10/08/2017
Date registered
13/09/2017
Date last updated
17/04/2024
Date data sharing statement initially provided
18/11/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Estrogen for the treatment of Borderline Personality Disorder
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Scientific title
A Randomised Placebo Controlled Trial of Estradiol for the Treatment of Women with Borderline Personality Disorder
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Secondary ID [1]
292628
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Borderline Personality Disorder
304345
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Condition category
Condition code
Mental Health
303678
303678
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0
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Psychosis and personality disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Female participants, aged 18-43, will be randomised to receive transdermal estradiol 1.5mg daily gel or placebo gel, as an adjunct to treatment as usual, for 12 weeks (84 days). Participants will be asked about adherence that will be completed at every study visit.
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Intervention code [1]
298854
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Treatment: Drugs
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Comparator / control treatment
Placebo Group/ gel
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Control group
Placebo
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Outcomes
Primary outcome [1]
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The Primary Outcome will be the mean change over time in the Borderline Personality Disorder Severity Index (BPDSI-IV) from baseline (Visit 1) over the 84 day treatment period.
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Assessment method [1]
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Timepoint [1]
303043
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Baseline and Day 84
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Primary outcome [2]
303258
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Proportion of participants in each group achieving clinical improvement defined by a decrease of equal to or more than 11.7 points on the Borderline Personality Disorder Severity Index (BPDSI-IV).
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Assessment method [2]
303258
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Timepoint [2]
303258
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Baseline, Day 84.
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Secondary outcome [1]
337760
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To measure potential change in emotional regulation assessed by 'The Difficulties in Emotion Regulation Scale' ; a 36 item scale that assesses ways that emotions are experienced, approached and processed.
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Assessment method [1]
337760
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Timepoint [1]
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Baseline, 84 days.
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Secondary outcome [2]
338125
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To measure potential change in cognitive and affective empathy, assessed by The Multifaceted Empathy Test (MET).
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Assessment method [2]
338125
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Timepoint [2]
338125
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Baseline, Day 84
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Secondary outcome [3]
338455
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To measure potential change in Dissociative Experience Scales (DES), a 28-question self-reported assessment for multi-modulatory experiences of dissociation.
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Assessment method [3]
338455
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Timepoint [3]
338455
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Day 0, Day 84.
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Eligibility
Key inclusion criteria
– Age 18-43 years
– Female
– Primary diagnosis of BPD, assessed by the Diagnostic Interview for Borderline Patients (DIB-R)
– Be willing to use appropriate barrier contraceptive precaution for the duration of the study
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Minimum age
18
Years
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Maximum age
43
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Known history of breast, endometrial or ovarian cancer
Women aged 40 or over who have not had a normal mammogram in the last 24 months
Abnormal pap smear in the last 24 months
Contraindications to estradiol
Current pregnancy or trying to become pregnant,
History of blood clots (e.g. deep vein thrombosis, pulmonary embolism)
Previous arterial thromboembolic disease (e.g. stroke)
Acute, high risk of suicide such that inpatient admission is required, as determined by PI Kulkarni (psychiatrist) based on her expert clinical assessment.
Taking more than 5 psychotropic medications
Taking OCP that do not have 20, 30 or 35mcg estradiol component
New/ planned changes to psychotropic medication/psychotherapy plans
Consistent, severe substance abuse in last 3 months
Smoking more than 20 cigarettes per day
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The Alfred Clinical Trials Pharmacy will perform trial randomisation, allocate and dispense treatment. Study participants and research staff will remain blind to the intervention. A designated senior staff member who is not involved in the conduct of the study will facilitate unblinding due to any adverse event. Participants will receive notification of their results after the study is completed.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Participants who pass screening will be assigned by a computer generated 2:1 block randomisation to be allocated to one of the study arms
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
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Intervention assignment
Parallel
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Other design features
The Alfred Clinical Trials Pharmacy will perform trial randomisation, allocate and dispense treatment. Study participants and research staff will remain blind to the intervention. A designated senior staff member who is not involved in the conduct of the study will facilitate unblinding due to any adverse event. Participants will receive notification of their results after the study is completed.
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Phase
Phase 2
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The longitudinal main outcomes will be analysed using generalised estimating equations in an intention to treat manner (SPSS statistical software).
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
13/01/2020
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Actual
11/11/2022
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Date of last participant enrolment
Anticipated
30/04/2025
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Actual
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Date of last data collection
Anticipated
31/07/2024
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Actual
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Sample size
Target
72
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Accrual to date
2
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Monash Alfred Psychiatry Research Centre - Melbourne
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Recruitment hospital [2]
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The Alfred - Prahran
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Recruitment postcode(s) [1]
16875
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3004 - Melbourne
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Recruitment postcode(s) [2]
16876
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3004 - Prahran
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Funding & Sponsors
Funding source category [1]
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Other
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Name [1]
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Monash Alfred Psychiatry Research Centre
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Address [1]
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Level 4, 607 St Kilda Rd
Melbourne VIC 3004
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Country [1]
297259
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Australia
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Primary sponsor type
Hospital
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Name
Alfred Hospital
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Address
Commercial Rd
Melbourne Victoria, 3004
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Country
Australia
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Secondary sponsor category [1]
296231
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University
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Name [1]
296231
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Monash University
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Address [1]
296231
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Wellington Road, Clayton Victoria 3800
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Country [1]
296231
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
298376
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Alfred Human Research and Ethics Committee
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Ethics committee address [1]
298376
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Old Baker Building, Level 1, 55 Commercial Rd, Melbourne VIC 3004
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Ethics committee country [1]
298376
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Australia
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Date submitted for ethics approval [1]
298376
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26/09/2017
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Approval date [1]
298376
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10/01/2019
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Ethics approval number [1]
298376
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Summary
Brief summary
Overview & Rationale: Borderline Personality Disorder (BPD) is a serious and highly prevalent (5.9%) psychiatric disorder. BPD sufferers experience severe emotional instability, social and occupational dysfunction, and engage in chronic self-mutilation and suicidal behaviours, with associated high levels of mortality, morbidity, and health service use. BPD patients are a complex group that are challenging to treat. Current psychological treatments are expensive and difficult for BPD patients to access, and there is currently no clearly designated pharmacotherapy. Underpinned by psychosocial causes, the pathogenesis of BPD is only now beginning to be understood. Childhood trauma is reported in most patients (>80%) and is linked to abnormalities in the development of the hypothalamus-pituitary-adrenal stress axis and, consequently, abnormalities in the hypothalamus-pituitary-gonadal axis. Both neuroendocrine axes have been reported as abnormal in BPD, indicating the neuroendocrine system as a potential therapeutic target for BPD symptoms. Significantly, cyclical fluctuations in ovarian hormones affect emotional and cognitive behaviours relevant to BPD. We propose to conduct a 12-week, double blind, placebo controlled two arm trial of i.) transdermal estradiol gel 2 pumps (1 pump =1.25mg gel = 0.75mg estradiol, total = 1.5mg daily estradiol) vs ii.) placebo inactive gel 2 pumps daily (in addition to treatment as usual), in a total of 72 women with BPD/CPTSD (48 for the estradiol arm and 24 for the placebo arm) over 12 weeks. Primary Aim: To determine whether estradiol is effective in treating symptoms of BPD/CPTSD. Secondary Aims: To determine if estradiol has effect on specific BPD/CPTSD symptom domains including: a) social - emotional regulation; b) cognition, including memory, decision making and executive functioning; c) concomitant mood and quality of life; and d) biological markers
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
76878
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Prof Jayashri Kulkarni
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Address
76878
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Monash Alfred Psychiatry Research Centre
Level 4, 607 St Kilda Rd
Melbourne VIC 3004
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Country
76878
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Australia
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Phone
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+61 3 9076 6564
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Fax
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Email
76878
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[email protected]
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Contact person for public queries
Name
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Emorfia Gavrilidis
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Address
76879
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Monash Alfred Psychiatry Research Centre
Level 4, 607 St Kilda Rd
Melbourne VIC 3004
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Country
76879
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Australia
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Phone
76879
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+61 3 90766564
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Fax
76879
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Email
76879
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[email protected]
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Contact person for scientific queries
Name
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Jayashri Kulkarni
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Address
76880
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Monash Alfred Psychiatry Research Centre
Level 4, 607 St Kilda Rd
Melbourne VIC 3004
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Country
76880
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Australia
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Phone
76880
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+61 3 9076 6564
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Fax
76880
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Email
76880
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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