ELONVA is the first in the class of sustained follicle stimulants (SFS). Due to its ability to initiate and sustain multiple follicular growth for an entire week, a single subcutaneous injection of the recommended dose of ELONVA may replace the first seven injections of any daily recombinant follicle stimulating hormone (rFSH) preparation in a COS treatment cycle.
"ELONVA will reduce the burden of injections for women experiencing difficulty conceiving, and the positive opinion is an important step toward a European approval," said Mirjam Mol-Arts, senior vice president, Merck Research Laboratories. "ELONVA demonstrates Merckâs commitment to providing effective patient-focused fertility treatments and extends the company's leadership in this therapy area."
The Phase III development program for ELONVA included the Engage trial, the largest double-blind fertility agent trial ever performed. The ongoing pregnancy rate, the primary endpoint of Engage, in the ELONVA treatment arm (38.9 percent per started cycle) was similar to that achieved in patients receiving a daily dose of rFSH for seven days (38.1 percent per started cycle).(1)
ELONVA is an investigational product being developed as a potential treatment in COS in combination with a GnRH antagonist for the development of multiple follicles in women participating in an ART program. ELONVA is designed as an SFS with the same pharmacodynamic profile as rFSH, but with a markedly prolonged duration of FSH activity. Due to its ability to initiate and sustain multiple follicular growth for an entire week, a single subcutaneous injection of the recommended dose of ELONVA may replace the first seven injections of any daily rFSH preparation in a COS treatment cycle.
Engage was a non-inferiority trial designed to compare ELONVA 150 mcg to 200 IU rFSH. A total of 1,506 patients (with a body weight greater than 60 kg) at 34 in-vitro fertilization (IVF) clinics in North America and Europe were randomized to receive either ELONVA 150 mcg or a daily dose of 200 IU rFSH, followed by rFSH (maximum 200 IU/day) from stimulation day eight onward, when required. Starting on stimulation day five, all patients received 0.25mg gonadotropin-releasing hormone (GnRH) antagonist until triggering of final oocyte maturation by human chorionic gonadotropin (hCG). The primary endpoint was the ongoing pregnancy rate assessed at ten weeks or more after embryo transfer. In the ELONVA treatment arm the ongoing pregnancy rate (38.9 percent per started cycle) was similar to that achieved in patients receiving a daily dose of rFSH for seven days (38.1 percent per started cycle).(1) The number of oocytes retrieved per attempt, the co-primary endpoint, was 13.7 (Â± 8.2) for the ELONVA group and 12.5 (Â± 6.7) for the rFSH group.(1)
Infertility is a disease or condition that impairs the body's ability to perform the basic function of reproduction.(2) It is often diagnosed after a couple has not conceived after one year of unprotected, well-timed intercourse.(3) Women over the age of 35 are encouraged to seek diagnosis and treatment for infertility following six months of unprotected intercourse.(4) Around 15 percent of couples of reproductive age have a fertility problem.(3)
There are many causes of infertility including problems with the production of sperm or eggs, with the fallopian tubes or the uterus, endometriosis, frequent miscarriage, as well as hormonal and autoimmune (antibody) disorders in both men and women.(3)
With infertile couples, the source of infertility lies with the male in 40 percent of cases and 40 percent with the female. The remaining 20 percent is either a joint problem or unknown, because the cause has not been identified. There are a variety of treatments available for infertility; these include surgery, hormone treatments, insemination, IVF and natural treatments, among others.(3)
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1. Devroey P, et al. A double-blind non-inferiority, randomized controlled trial comparing corifollitropin alfa and recombinant FSH during the first seven days of ovarian stimulation using a GnRH antagonist protocol. Hum Reprod 2009; doi: 10.1093/humrep/dep291.
2. Frequently Asked Questions About Infertility. American Society for Reproductive Medicine Web site. http://www.asrm.org/Patients/faqs.html. Accessed May 14, 2009
3. http://www.icsi.ws/about_infertility. Accessed May 14, 2009
4. Frequently Asked Questions; Questions about Infertility. Centre for Fertility and Reproductive Medicine. http://www.csmc.edu/3830.html. Accessed May 14, 2009.