INTRODUCING THE RELIEF REGISTRY
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Transcript INTRODUCING THE RELIEF REGISTRY
INTRODUCING THE
RELIEF REGISTRY
Dr. Jaron Rabinovici
Sheba Medical Center, Israel
Personal Experience with Focused Ultrasound
Performed the second uterine fibroid FUS treatment (First
treatment at Harvard Medical School)
• Participated in the first studies, pivotal study
• Since then more than 300 uterine fibroid treatment at our Center
Treated the first patient who got pregnant after FUS
• Published the first “pregnancy paper” on 52 pregnancies after
Introduced the possibility to treat adenomyosis
• First study to demonstrate clinical efficacy and safety
Head of gynecological activity of Insightec Focused Ultrasound
Center at Sheba Medical Center, Israel
Many invited lectures
© 2013 by Focused Ultrasound Foundation
© 2013 by Focused Ultrasound Foundation
Acceptance of Focused Ultrasound
Treatment for Uterine Fibroids
Over the last decade ~ 10,000 treatments in ~ 100
centers!
Centers that managed to obtain some form of
reimbursement managed to perform many
procedures!
© 2013 by Focused Ultrasound Foundation
Problems in the Implementation
of Focused Ultrasound for Fibroids
New technology
• Physicians are conservative and “afraid” of new/unfamiliar approaches
• Focused Ultrasound is available only in a limited number of centers
• High “entry fee”
• Need for good and extensive scientific data
• Most data based on one center, limited observational studies
• Need for extensive post-marketing experience
• Lack of extensive long-term experience/data
Multiple Alternatives
• Big competition, “difficult sale”
Treatment price
• Limited adoption by insurance carriers
© 2013 by Focused Ultrasound Foundation
Problems in the Implementation
of Focused Ultrasound for Fibroids
New technology
• Physicians are conservative and “afraid” of new/unfamiliar approaches
• Focused Ultrasound is available only in a limited number of centers
• High “entry fee”
• Need for good and extensive scientific data
• Most data based on one center, limited observational studies
• Need for extensive post-marketing experience
• Lack of extensive long-term experience/data
Multiple Alternatives
• Big competition, “difficult sale”
Treatment price
• Limited adoption by insurance carriers
© 2013 by Focused Ultrasound Foundation
“Needed” Studies for Focused Ultrasound
Randomized Controlled Studies?
RCT’s vs “gold standard” (which?)
• Difficult to impossible to perform.
• Random decision of invasive versus non-invasive
treatment?
• Difficult recruitment, very expensive, variable results
from various centers can affect outcome, examines a
predefined patient population.
© 2013 by Focused Ultrasound Foundation
“Needed” Studies for Focused Ultrasound
Registry Studies?
• Prospective entry of consecutive patients can provide
data on clinical procedures – “real life”
• Able to gather data on many patients within a limited
time frame and follow them up for a prolonged period
of time
• The resulting reports and publications should provide a
large body of evidence that will be difficult to disregard
© 2013 by Focused Ultrasound Foundation
Gathering Evidence, Expanding Access
Focused Ultrasound for Uterine Fibroids
Registry Goal: Provide large scale evidence on
safety, efficacy and long-term durability of Focused
Ultrasound, to facilitate reimbursement and drive
rapid patient and physician acceptance
© 2013 by Focused Ultrasound Foundation
REgistry for Leiomyoma: International Efficacy of Focused
Ultrasound
3-year, single-arm, prospective, global registry
1,000 women treated with MR-guided FUS at 30+ treatment
sites
Led by Steering Committee of international, leading experts
Funded by philanthropy and industry
© 2013 by Focused Ultrasound Foundation
Steering Committee
Chair: Jaron Rabinovici, MD, Sheba Medical Center, Israel
Anne Roberts, MD, University of California, San Diego
Elizabeth A. Stewart, MD, Mayo Clinic, Rochester
Robert K. Zurawin, MD, Baylor College of Medicine, Houston
Elizabeth David, MD, Sunnybrook Health Sciences Centre,
Toronto, Canada
Wladyslaw M. Gedroyc, MD, St. Mary's Hospital, London, UK
Young-Sun Kim, MD, Samsung Medical Center, Seoul, South
Korea
Matthias Matzko, MD, Amper Kliniken, Dachau, Germany
Harsh Rastogi, MD, Indraprastha Apollo Hospital, New Delhi,
India
© 2013 by Focused Ultrasound Foundation
RELIEF Registry
Hypothesis
Hypothesis: Focused Ultrasound will provide a
durable improvement for women with symptomatic
uterine fibroids.
© 2013 by Focused Ultrasound Foundation
RELIEF Registry
Objectives
Primary Objectives: Provide large scale evidence
on the safety and long term efficacy of Focused
Ultrasound for the indication of symptomatic uterine
fibroids
Secondary Objectives: Assess the impact of the
treatment on medical resource utilization and
pregnancy outcomes
© 2013 by Focused Ultrasound Foundation
RELIEF Registry
Outcomes of Interest
Primary endpoints:
• Treatment effectiveness using UFS-SSS
• Need/reason for alternative treatments
• Treatment safety using adverse events
Secondary endpoints:
• Treatment satisfaction
• Recovery using return to work and/or normal activities
Exploratory endpoints:
• Medical resources utilization
• Pregnancy outcomes
• General health-related quality life
© 2013 by Focused Ultrasound Foundation
RELIEF Registry
Registry Design
Target –1,000 women in two years, three years
follow-up.
Approximately 30 sites in:
• North America - U.S., Canada
• Europe - Germany, United Kingdom
• Asia - Korea, India, Israel
Each site will enroll approximately 50 consecutive
patients who receive Focused Ultrasound
© 2013 by Focused Ultrasound Foundation
PROTOCOL
1,000
planning
to be treated
using focused ultrasound
Complete
baseline
Survey
~30 Sites
Treatment Information:
Duration,
Number of fibroids
Treated fibroids
Fibroid volume, NPV
AEs
Self-report
© 2013 by Focused Ultrasound Foundation
Baseline:
Demographics
Gynecologic history
Uterine, fibroid anatomy
Future fertility
Symptoms and QoL
Treatment
Treatment form
completed
1 month,
6 month,
1-2-3 year surveys
Complete
study
Follow-up Measures:
Additional treatments
Treatment Satisfaction
Resource utilization
Pregnancy outcomes
AEs
Symptoms and QoL
RELIEF Registry
Patient Population
Inclusion
• Patient is
—Intended to be treated for symptomatic uterine fibroids by focused
ultrasound (consistent with local labeling)
—Able to communicate over the phone/internet and can complete study
questionnaires
—Willing to be followed for three years
Exclusion
• Patient is
—Pregnant at time of treatment
—Post-menopausal
© 2013 by Focused Ultrasound Foundation
RELIEF Registry
Publications
Treatment guidelines
Structure
Baseline data
Short-term results
Mid-term results
Long-term results
Other analyses TBD
© 2013 by Focused Ultrasound Foundation
RELIEF Registry
Status
Enrollment to begin second half this year
Sites to come onboard soon – potential US
locations to include:
Bethesda, MD
Boca Raton, FL
Boston, MA
Charlottesville, VA
Chicago, IL
Columbus, OH
© 2013 by Focused Ultrasound Foundation
Houston, TX
Nashville, TN
Rochester, MN
San Diego, CA
San Francisco, CA
Stanford, CA
REFERRING PATIENTS TO RELIEF
Every patient treated in the U.S. will be
eligible for the registry
RELIEF will systematically collect data and
provide evidence-based recommendations for
patient selection and outcomes
www.fibroidrelief.org/registry
© 2013 by Focused Ultrasound Foundation