Segesterone acetate

Last updated
Segesterone acetate
Nestorone.svg
Segesterone acetate molecule ball.png
Clinical data
Trade names Nestorone, Elcometrine, Annovera
Other namesSGA; SA; Nestorone; Nestoron; Elcometrine; ST-1435; AC-6844; CS-0411; 16-Methylene-17α-acetoxy-19-norprogesterone; 16-Methylene-17α-acetoxy-19-norpregn-4-ene-3,20-dione
Routes of
administration 		Subcutaneous implant, vaginal ring, transdermal patch [1]
Drug class Progestogen; Progestin; Progestogen ester
ATC code
  • None
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability Oral: 10% [1] [2]
Protein binding 95% (to albumin and not to SHBG Tooltip sex hormone-binding globulin [1] [3] [4]
Metabolism Hydroxylation (CYP3A4), reduction (5α-reductase)
Elimination half-life Vaginal ring: 4.5 hours [4]
Parenteral: 24–72 hours [5] [6]
Oral: 1–2 hours [1]
Identifiers
  • [(8R,9S,10R,13S,14S,17R)-17-acetyl-13-methyl-16-methylidene-3-oxo-2,6,7,8,9,10,11,12,14,15-decahydro-1H-cyclopenta[a]phenanthren-17-yl] acetate
CAS Number
PubChem CID
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula C23H30O4
Molar mass 370.489 g·mol−1
3D model (JSmol)
  • O=C4\C=C2/[C@@H]([C@H]1CC[C@@]3([C@](OC(=O)C)(C(=C)\C[C@H]3[C@@H]1CC2)C(=O)C)C)CC4
  • InChI=1S/C23H30O4/c1-13-11-21-20-7-5-16-12-17(26)6-8-18(16)19(20)9-10-22(21,4)23(13,14(2)24)27-15(3)25/h12,18-21H,1,5-11H2,2-4H3/t18-,19+,20+,21-,22-,23-/m0/s1
  • Key:CKFBRGLGTWAVLG-GOMYTPFNSA-N

Segesterone acetate (SGA), sold under the brand names Nestorone, Elcometrine, and Annovera, is a progestin medication which is used in birth control and in the treatment of endometriosis in the United States, Brazil, and other South American countries. [1] [4] [7] It is available both alone and in combination with an estrogen. [1] [4] [7] It is not effective by mouth and must be given by other routes, most typically as a vaginal ring or implant that is placed into fat. [1] [4] [8]

Contents

Side effects of SGA are similar to those of other progestins. SGA is a progestin, or a synthetic progestogen, and hence is an agonist of the progesterone receptor, the biological target of progestogens like progesterone. [1] [3] [9] [10] It has some affinity for the glucocorticoid receptor and has no other important hormonal activity. [1] [3] [9] [10]

SGA was developed by the Population Council and was introduced for medical use by 2000. [7] [11] It is under development in the United States and Europe as a gel in combination with estradiol or testosterone for use as a method of birth control in women and in men, respectively. [12] [13] [14] [15] On August 10, 2018, a first-of-its-kind one-year contraceptive vaginal ring containing segesterone acetate in combination with ethinyl estradiol was approved in the United States. [4] [16] It is marketed under the brand name Annovera and is reusable for up to one year as a method of birth control in women. Annovera does not require refrigeration which is very useful for low resource areas. [4] [17]

Medical uses

SGA is used as a hormonal contraceptive and in the treatment of endometriosis. [1] [4] [7]

Available forms

Side effects

Side effects of SGA are similar to those of other progestins.[ citation needed ]

Pharmacology

Pharmacodynamics

SGA acts primarily as a high-affinity agonist of the progesterone receptor (272% of the affinity of progesterone and 136% of that of promegestone). [3] It does not bind significantly to the androgen receptor, estrogen receptor, or mineralocorticoid receptor. [3] [9] As such, SGA does not have estrogenic, androgenic, antiandrogenic, or antimineralocorticoid activity. [5] However, SGA does have significant affinity for the glucocorticoid receptor (38% of that of dexamethasone), but in spite of its relatively high affinity for the glucocorticoid receptor, it either does not have any glucocorticoid effects or shows glucocorticoid effects only at exceptionally high doses in animals. [1] [3] [10] SGA has no antiglucocorticoid activity in animals either. [10] The ovulation-inhibiting dosage of parenteral SGA has been reported to be 150 μg per day, while the endometrial transformation dosage has been reported to be 600 μg per cycle. [5] SGA has antigonadotropic effects and functional antiestrogenic effects via its progestogenic activity similarly to other progestogens. [3] [5] In healthy young men, SGA alone at a dose of 2 to 3 mg/day as a transdermal gel (delivering 200–300 μg/day SGA) for 2 weeks suppressed testosterone levels from ~581 ng/dL to ~276 ng/dL (–52%). [18]

Pharmacokinetics

SGA is only weakly active orally, and is instead given as a subcutaneous implant. [8] The oral bioavailability of SGA has been reported to be only 10%. [1] [2] However, it has also been reported that the medication is more than 100-fold as potent when delivered via subcutaneous implant relative to oral administration in rats. [1] [3] It has been estimated that SGA administered at a dose of 2 to 3 mg/day in the form of a transdermal gel delivers approximately 200 to 300 μg/day SGA based on a transdermal bioavailability of about 10 to 12%. [18] SGA is bound to albumin. [1] [3] It does not bind to sex hormone-binding globulin. [1] [3] Segesterone, the deacetylated form of SGA, is a metabolite of the medication. [19] The biological half-life of parenteral SGA has been reported to be 24 to 72 hours. [5] [6] One study specifically reported a biological half-life of 26.8 hours. [6] It has been reported that the biological half-life of SGA with oral administration is only 1 to 2 hours. [1] In contrast to all of the preceding however, the Food and Drug Administration (FDA) label for Annovera, a one-year vaginal ring containing ethinylestradiol and SGA, lists a circulating half-life of SGA of 4.5 hours. [4]

Chemistry

SGA, also known as 16-methylene-17α-acetoxy-19-norprogesterone or as 16-methylene-17α-acetoxy-19-norpregn-4-ene-3,20-dione, is a synthetic norpregnane steroid and a derivative of progesterone. It is a combined derivative of 17α-hydroxyprogesterone and 19-norprogesterone, or a derivative of gestronol (17α-hydroxy-19-norprogesterone). The medication is the C17α acetate ester of segesterone, which, in contrast, was never marketed. [19] Other 19-norprogesterone derivatives include demegestone, gestonorone caproate (norhydroxyprogesterone caproate), nomegestrol acetate, promegestone, and trimegestone. [3] SGA is a derivative of 16-methylene-17α-hydroxyprogesterone acetate, and is the analogue of methenmadinone acetate without the C19 methyl group or the C6 double bond. [20] A derivative of SGA with even greater progestogenic potency in comparison to SGA is 18-methylsegesterone acetate. [21] [22] [23]

History

SGA was developed by the Population Council. [11] It has been marketed since at least 2000. [7]

Society and culture

Generic names

Segesterone acetate is the generic name of the drug and its USAN Tooltip United States Adopted Name. [24] [25] It is also known by its brand names nestorone and elcometrine, [26] as well as by its former developmental code names ST-1435, AC-6844, and CS-0411.[ citation needed ]

Brand names

SGA is marketed alone under the brand names Nestorone and Elcometrine and in combination with ethinylestradiol under the brand name Annovera. [4] [7]

Availability

SGA is available alone in several South American countries, including Brazil. [1] It is available in the United States as a contraceptive vaginal ring in combination with ethinylestradiol. [4]

Research

A combination of SGA and the estrogen estradiol is under development in a transdermal gel formulation for use as a contraceptive in women by the Population Council in conjunction with Antares Pharma in the United States and Europe. [12] [14] As of December 2017, it is in phase III clinical trials for this indication. [12] The medication has the tentative brand name NestraGel. [12] A combination of SGA and the estrogen ethinylestradiol in a vaginal ring formulation for use as a one-year contraceptive was developed by the Population Council in multiple regions including Latin America, Europe, and Australia. [17] It completed phase III clinical trials and [17] was approved in the United States in August 2018. [4] [16]

A combination of SGA and the androgen testosterone is under development as a transdermal gel formulation for use as a hormonal contraceptive in men by the Population Council. [13] [15] As of December 2017, it is in phase II clinical studies for this purpose. [15] [27] In a trial, 100 couples used segesterone/testosterone dermal gel as the sole contraception method, which resulted in no pregnancy. Side effects were described as mild, comprising acne, weight gain and nocturnal sweating. [28]

See also

Related Research Articles

<span class="mw-page-title-main">Progestogen (medication)</span> Medication producing effects similar to progesterone

A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a synthetic progestogen. Progestogens are used most commonly in hormonal birth control and menopausal hormone therapy. They can also be used in the treatment of gynecological conditions, to support fertility and pregnancy, to lower sex hormone levels for various purposes, and for other indications. Progestogens are used alone or in combination with estrogens. They are available in a wide variety of formulations and for use by many different routes of administration. Examples of progestogens include natural or bioidentical progesterone as well as progestins such as medroxyprogesterone acetate and norethisterone.

<span class="mw-page-title-main">Ethinylestradiol</span> Estrogen medication

Ethinylestradiol (EE) is an estrogen medication which is used widely in birth control pills in combination with progestins. In the past, EE was widely used for various indications such as the treatment of menopausal symptoms, gynecological disorders, and certain hormone-sensitive cancers. It is usually taken by mouth but is also used as a patch and vaginal ring.

<span class="mw-page-title-main">Desogestrel</span> Medication

Desogestrel is a progestin medication which is used in birth control pills for women. It is also used in the treatment of menopausal symptoms in women. The medication is available and used alone or in combination with an estrogen. It is taken by mouth.

<span class="mw-page-title-main">Drospirenone</span> Medication drug

Drospirenone is a progestin and antiandrogen medication which is used in birth control pills to prevent pregnancy and in menopausal hormone therapy, among other uses. It is available both alone under the brand name Slynd and in combination with an estrogen under the brand name Yasmin among others. The medication is an analog of the drug spironolactone. Drospirenone is taken by mouth.

<span class="mw-page-title-main">Norethisterone acetate</span> Chemical compound

Norethisterone acetate (NETA), also known as norethindrone acetate and sold under the brand name Primolut-Nor among others, is a progestin medication which is used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. The medication available in low-dose and high-dose formulations and is used alone or in combination with an estrogen. It is ingested orally.

<span class="mw-page-title-main">Norelgestromin</span> Pharmaceutical drug

Norelgestromin, or norelgestromine, sold under the brand names Evra and Ortho Evra among others, is a progestin medication which is used as a method of birth control for women. The medication is available in combination with an estrogen and is not available alone. It is used as a patch that is applied to the skin.

<span class="mw-page-title-main">Norgestimate</span> Chemical compound

Norgestimate, sold under the brand names Ortho Tri-Cyclen and Previfem among others, is a progestin medication which is used in birth control pills for women and in menopausal hormone therapy. The medication is available in combination with an estrogen and is not available alone. It is taken by mouth.

<span class="mw-page-title-main">Norethisterone</span> Progestin medication

Norethisterone, also known as norethindrone and sold under many brand names, is a progestin medication used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. The medication is available in both low-dose and high-dose formulations and both alone and in combination with an estrogen. It is used by mouth or, as norethisterone enanthate, by injection into muscle.

<span class="mw-page-title-main">Gestodene</span> Progestin medication

Gestodene, sold under the brand names Femodene and Minulet among others, is a progestin medication which is used in birth control pills for women. It is also used in menopausal hormone therapy. The medication is available almost exclusively in combination with an estrogen. It is taken by mouth.

<span class="mw-page-title-main">Gestonorone caproate</span> Chemical compound

Gestonorone caproate, also known as gestronol hexanoate or norhydroxyprogesterone caproate and sold under the brand names Depostat and Primostat, is a progestin medication which is used in the treatment of enlarged prostate and cancer of the endometrium. It is given by injection into muscle typically once a week.

<span class="mw-page-title-main">Dienogest</span> Chemical compound

Dienogest, sold under the brand name Visanne among others, is a progestin medication which is used in birth control pills and in the treatment of endometriosis. It is also used in menopausal hormone therapy and to treat heavy periods. Dienogest is available both alone and in combination with estrogens. It is taken by mouth.

<span class="mw-page-title-main">Chlormadinone acetate</span> Chemical compound

Chlormadinone acetate (CMA), sold under the brand names Belara, Gynorelle, Lutéran, and Prostal among others, is a progestin and antiandrogen medication which is used in birth control pills to prevent pregnancy, as a component of menopausal hormone therapy, in the treatment of gynecological disorders, and in the treatment of androgen-dependent conditions like enlarged prostate and prostate cancer in men and acne and hirsutism in women. It is available both at a low dose in combination with an estrogen in birth control pills and, in a few countries like France and Japan, at low, moderate, and high doses alone for various indications. It is taken by mouth.

<span class="mw-page-title-main">Norethisterone enanthate</span> Chemical compound

Norethisterone enanthate (NETE), also known as norethindrone enanthate, is a form of hormonal birth control which is used to prevent pregnancy in women. It is used both as a form of progestogen-only injectable birth control and in combined injectable birth control formulations. It may be used following childbirth, miscarriage, or abortion. The failure rate per year in preventing pregnancy for the progestogen-only formulation is 2 per 100 women. Each dose of this form lasts two months with only up to two doses typically recommended.

<span class="mw-page-title-main">Trimegestone</span> Chemical compound

Trimegestone, sold under the brand names Ondeva and Totelle among others, is a progestin medication which is used in menopausal hormone therapy and in the prevention of postmenopausal osteoporosis. It was also under development for use in birth control pills to prevent pregnancy, but ultimately was not marketed for this purpose. The medication is available alone or in combination with an estrogen. It is taken by mouth.

<span class="mw-page-title-main">Nomegestrol acetate</span> Chemical compound

Nomegestrol acetate (NOMAC), sold under the brand names Lutenyl and Zoely among others, is a progestin medication which is used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. It is available both alone and in combination with an estrogen. NOMAC is taken by mouth. A birth control implant for placement under the skin was also developed but ultimately was not marketed.

<span class="mw-page-title-main">19-Norprogesterone</span> Chemical compound

19-Norprogesterone, also known as 19-norpregn-4-ene-3,20-dione, is a steroidal progestin and close analogue of the sex hormone progesterone, lacking only the C19 methyl group of that molecule. It was first synthesized in 1944 in the form of a mixture that also included unnatural stereoisomers of progesterone, and this mixture was found to be at least equivalent to progesterone in terms of progestogenic activity. Subsequent investigations revealed that 17-isoprogesterone and 14-iso-17-isoprogesterone are devoid of progestogenic activity. 19-Norprogesterone was resynthesized in 1951 with an improved method, and was confirmed to be the component of the mixture synthesized in 1944 that was responsible for its progestogenic activity. In 1953, a paper was published showing that 19-norprogesterone possessed 4- to 8-fold the activity of progesterone in the Clauberg assay in rabbits, and at the time of this discovery, 19-norprogesterone was the most potent progestogen known.

<span class="mw-page-title-main">Norgesterone</span> Chemical compound

Norgesterone, also known as norvinodrel or vinylestrenolone and sold under the brand name Vestalin, is a progestin medication which was formerly used in birth control pills for women but is now no longer marketed. It was used in combination with the estrogen ethinylestradiol. It is taken by mouth.

<span class="mw-page-title-main">Progestogen ester</span> Drug class

A progestogen ester is an ester of a progestogen or progestin. The prototypical progestogen is progesterone, an endogenous sex hormone. Esterification is frequently employed to improve the pharmacokinetics of steroids, including oral bioavailability, lipophilicity, and elimination half-life. In addition, with intramuscular injection, steroid esters are often absorbed more slowly into the body, allowing for less frequent administration. Many steroid esters function as prodrugs.

<span class="mw-page-title-main">Estradiol (medication)</span> Steroidal hormone medication

Estradiol (E2) is a medication and naturally occurring steroid hormone. It is an estrogen and is used mainly in menopausal hormone therapy and to treat low sex hormone levels in women. It is also used in hormonal birth control for women, in feminizing hormone therapy for transgender women, and in the treatment of hormone-sensitive cancers like prostate cancer in men and breast cancer in women, among other uses. Estradiol can be taken by mouth, held and dissolved under the tongue, as a gel or patch that is applied to the skin, in through the vagina, by injection into muscle or fat, or through the use of an implant that is placed into fat, among other routes.

<span class="mw-page-title-main">18-Methylsegesterone acetate</span> Chemical compound

18-Methylsegesterone acetate is a progestin medication of the 19-norprogesterone group which was never marketed. It was first described in a patent in 1997 and then in a literature paper in 2003. 18-Methyl-SGA is the C18 methyl or C13β ethyl derivative of segesterone acetate, and shows 3 to 10 times the progestogenic potency of SGA in bioassays. This is analogous to the case of the 19-nortestosterone progestin norethisterone and its 18-methyl derivative levonorgestrel, the latter showing substantially increased potency relative to the former similarly. As SGA is already one of the most potent progestins to have been developed, with 100-fold the potency of progesterone and 10-fold the potency of levonorgestrel in bioassays, 18-methyl-SGA is an extremely potent progestogen, among if not the most potent known.

References

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  28. ↑ Stöckel M (2022-06-13). "Verhütung für den Mann: Das Hormon-Gel lässt hoffen" [Contraception for men: The hormone gel inspires hope] (in German). Swiss Radio and Television SRF. Retrieved 2022-06-15.
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