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Trial · Interventional

CompletedPhase 2Results postedRegistry data

Investigation of Safety and Efficacy of Once-daily Semaglutide in Obese Subjects Without Diabetes Mellitus

NCTNCT02453711 (opens ClinicalTrials.gov in a new tab)Other idNN9536-4153Other id2014-001540-38Other idU1111-1155-4660Other id2014

Overview

Status
Completed
Phase
Phase 2
Enrollment
957 participants (actual)
Sponsor
Novo Nordisk A/S · Industry
Design
Randomized · Double masking
Countries
8 countries

United States, Australia, Belgium, Canada, Germany, Israel, Russia, United Kingdom

Start
1 Oct 2015
Primary completion
30 Mar 2017
Completion
12 Apr 2017
First posted
25 May 2015 (estimated)
Last update posted
17 Apr 2020
Conditions
Metabolism and Nutrition Disorder · Obesity

Timeline

1 trial · 1 completed · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
2015201620172018
  1. Ph 2

    Investigation of Safety and Efficacy of Once-daily Semaglutide in Obese Subjects Without Diabetes Mellitus

    NCT02453711

    1 Oct 2015 to 12 Apr 2017

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

This trial is conducted globally. The aim of this trial is to investigate safety and efficacy of once-daily semaglutide in obese subjects without diabetes mellitus.

Interventions

  • semaglutideDrug
  • liraglutideDrug
  • placeboDrug

Arms16

  • Experimental

    Sema 0.05 mg

    Dose 0.05 mg

  • Experimental

    Sema 0.1 mg

    Dose 0.05 or 0.1 mg with dose escalation every fourth week

  • Experimental

    Sema 0.2 mg

    Dose 0.05, 0.1 or 0.2 mg with dose escalation every fourth week

  • Experimental

    Sema 0.3 mg

    Dose 0.05, 0.1, 0.2 or 0.3 mg with dose escalation every fourth week

  • Experimental

    Sema 0.4 mg

    Dose 0.05, 0.1, 0.2, 0.3, or 0.4 mg with dose escalation every fourth week

  • Experimental

    Sema 0.3 mg (fast dose escalation)

    Dose 0.05, 0.1, 0.2 or 0.3 mg with dose escalation every second week

  • Experimental

    Sema 0.4 mg (fast dose escalation)

    Dose 0.05, 0.1, 0.2, 0.3, or 0.4 mg with dose escalation every second week

  • Active comparator

    Lira 3.0 mg

    Dose 0.6, 1.2, 1.8, 2.4, 3.0 mg with dose escalation every week

  • Placebo comparator

    Placebo Sema 0.05 mg

    Placebo arm matching active arm Sema 0.05 mg

  • Placebo comparator

    Placebo Sema 0.1 mg

    Placebo arm matching active arm Sema 0.1 mg

  • Placebo comparator

    Placebo Sema 0.2 mg

    Placebo arm matching active arm Sema 0.2 mg

  • Placebo comparator

    Placebo Sema 0.3 mg

    Placebo arm matching active arm Sema 0.3 mg

  • Placebo comparator

    Placebo Sema 0.4 mg

    Placebo arm matching active arm Sema 0.4 mg

  • Placebo comparator

    Placebo Sema 0.3 mg (fast dose escalation)

    Placebo arm matching active arm Sema 0.3 mg (fast dose escalation)

  • Placebo comparator

    Placebo Sema 0.4 mg (fast dose escalation)

    Placebo arm matching active arm Sema 0.4 mg (fast dose escalation)

  • Placebo comparator

    Placebo Lira 3.0 mg

    Placebo arm matching active arm Lira 3.0 mg

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Relative Change in Body Weight (%)

    Time frame · Week 0, Week 52

    Registry description

    Relative change from baseline (week 0) in body weight was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline body weight as covariate. In-trial observation period was defined as the period from randomisation to last contact with trial site.

Secondary outcomes(20)
  1. Participants With Weight Loss of ≥5% of Baseline Body Weight

    Time frame · Week 52

    Registry description

    Presented results are percentage of participants who lost more than or equal to 5% of their baseline (week 0) body weight at week 52. Analysis of observed in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using a binary logistic regression model with treatment, region and sex as factors and baseline body weight as covariate. In-trial observation period was defined as the period from randomisation to last contact with trial site.

  2. Participants With Weight Loss of ≥10% of Baseline Body Weight

    Time frame · Week 52

    Registry description

    Presented results are percentage of participants who lost more than or equal to 10% of their baseline (week 0) body weight at week 52. Analysis of observed in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using a binary logistic regression model with treatment, region and sex as factors and baseline body weight as covariate. In-trial observation period was defined as the period from randomisation to last contact with trial site.

  3. Change in Body Weight (kg)

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in body weight was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline body weight as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  4. Change in Waist Circumference

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in waist circumference was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline waist circumference as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  5. Change in Waist to Hip Circumference Ratio

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in waist to hip circumference ratio was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline waist to hip circumference ratio as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  6. Change in BMI

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in body mass index (BMI) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline BMI as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  7. Change in HbA1c

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in glycosylated haemoglobin (HbA1c) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline HbA1c as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  8. Change in FPG

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in fasting plasma glucose (FPG) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline FPG as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  9. Change in Glycaemic Category (Normoglycaemia, Pre-diabetes, T2D)

    Time frame · Week 0, Week 52

    Registry description

    The categorisation of glycaemic status as described in the protocol was not aligned with the usual diagnosis criteria which require repeated testing of blood glucose to confirm the diagnosis and allows for the diagnosis to be made based on random glucose assessments and/or 2-hour glucose assessments during an oral glucose tolerance test. Therefore, data were not collected for this outcome measure.

  10. Change in SBP

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in systolic blood pressure (SBP) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline SBP as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  11. Change in DBP

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in diastolic blood pressure (DBP) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline DBP as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  12. Change in Lipids (Total Cholesterol, LDL Cholesterol, HDL Cholesterol, VLDL Cholesterol, Triglycerides and FFA)

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in lipids (total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and triglycerides) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and respective baseline lipid value as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site. Free fatty acid (FFA) results are not presented as the values were considered invalid. The shipment of the samples to be tested for FFA was not as per the requirement.

  13. Change in hsCRP

    Time frame · Week 0, Week 52

    Registry description

    Change from baseline (week 0) in high-sensitivity C-reactive protein (hsCRP) was evaluated at week 52. Analysis of in-trial data with missing observations imputed from the pooled placebo arms based on a jump to reference multiple (x1000) imputation (J2R-MI) approach. Week 52 responses were analysed using an analysis of covariance model with treatment, region and sex as factors and baseline hsCRP as covariate. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  14. Change in IWQoL Lite

    Time frame · Week 0, Week 52

    Registry description

    The planned analyses of the Impact of Weight on Quality of Life Lite (IWQoL-Lite) for Clinical Trials scores were not performed. The measure was still under development, and Novo Nordisk had not obtained a validated scoring of the instrument by the time of analysis of the trial results. Therefore, the total and subdomain scores on the IWQoL-Lite could not be provided.

  15. Change in SF-36

    Time frame · Week 0, Week 52

    Registry description

    Short Form-36 (SF-36) is a 36-item patient-reported survey of patient health that measures the participant's overall health-related quality of life (HRQoL). SF-36v2™ (acute version) questionnaire measured eight domains of functional health and well-being as well as two component summary scores (physical component summary (PCS) and mental component summary (MCS)). The 0-100 scale scores (where higher scores indicated a better HRQoL) from the SF-36 were converted to norm-based scores to enable a direct interpretation in relation to the distribution of the scores in the 2009 U.S. general population. In the metric of norm-based scores, 50 and 10 corresponds to the mean and standard deviation respectively of the 2009 U.S. general population. Change from baseline (week 0) in the domain scores and component summary (PCS and MCS) scores were evaluated at week 52. A positive change score indicates an improvement since baseline. Results are based on the in-trial observation period.

  16. Participants With Change in Concomitant Medications (Antihypertensive and Lipid-lowering Medications)

    Time frame · Week 0, Week 52

    Registry description

    Participants' status on receiving concomitant medication (antihypertensive and lipid-lowering medications) at week 0 (yes/no) and week 52 (decreased, no change, increased or missing) are presented. Results are based on the on-treatment observation period which was defined as the period from first trial product administration to last trial product administration.

  17. Compliance With Nutritional Counselling

    Time frame · Week 4-52

    Registry description

    This outcome measure presents "nutritional compliance results" recorded at weeks 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48 and 52. Nutritional compliance was recorded on a 0 to 10 numeric rating scale (NRS), with higher scores representing better compliance.

  18. Number of AEs During the Trial

    Time frame · Week 0-59

    Registry description

    Adverse events (AEs) were recorded from week 0 to week 59. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  19. Number of Hypoglycaemic Episodes During the Trial

    Time frame · Week 0-59

    Registry description

    Hypoglycaemic episodes were identified by either: 1) Subject reporting of symptoms of hypoglycaemia (low blood sugar) or 2) fasting plasma glucose (FPG) values ≤3.9 mmol/L (70 mg/dL) from blood sampling at site visits. Hypoglycaemic episodes were recorded from week 0 to week 59. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

  20. Number of New and Ongoing Nausea, Vomiting, Diarrhoea, and Constipation Events by Week

    Time frame · Week 0-59

    Registry description

    Presented results are the number of nausea, vomiting, diarrhoea, and constipation events recorded from week 0 to week 59. Results are based on the in-trial observation period which was defined as the period from randomisation to last contact with trial site.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeLeast squares mean· Week 0, Week 52

Relative Change in Body Weight (%)

GroupValue (Percentage (%) of body weight)Spread
Semaglutide 0.05 mg-5.990.85
Semaglutide 0.1 mg-8.620.84
Semaglutide 0.2 mg-11.600.85
Semaglutide 0.3 mg-11.170.85
Semaglutide 0.4 mg-13.840.83
Semaglutide 0.3 mg (Fast Escalation)-11.380.85
Semaglutide 0.4 mg (Fast Escalation)-16.290.83
Liraglutide 3.0 mg-7.760.85
Placebo Pool-2.290.74
Secondary and other outcome results(7)
Secondary outcomeNumber· Week 52

Participants With Weight Loss of ≥5% of Baseline Body Weight

GroupValue (Percentage (%) of participants)
Semaglutide 0.05 mg53.50
Semaglutide 0.1 mg67.49
Semaglutide 0.2 mg74.91
Semaglutide 0.3 mg80.52
Semaglutide 0.4 mg82.52
Semaglutide 0.3 mg (Fast Escalation)72.19
Semaglutide 0.4 mg (Fast Escalation)89.58
Liraglutide 3.0 mg66.12
Placebo Pool22.87
Secondary outcomeNumber· Week 52

Participants With Weight Loss of ≥10% of Baseline Body Weight

GroupValue (Percentage (%) of participants)
Semaglutide 0.05 mg18.94
Semaglutide 0.1 mg36.57
Semaglutide 0.2 mg55.95
Semaglutide 0.3 mg57.76
Semaglutide 0.4 mg64.61
Semaglutide 0.3 mg (Fast Escalation)58.45
Semaglutide 0.4 mg (Fast Escalation)71.91
Liraglutide 3.0 mg33.98
Placebo Pool10.08
Secondary outcomeLeast squares mean· Week 0, Week 52

Change in Body Weight (kg)

GroupValue (Kilogram (kg))Spread
Semaglutide 0.05 mg-6.660.94
Semaglutide 0.1 mg-9.340.93
Semaglutide 0.2 mg-12.300.93
Semaglutide 0.3 mg-12.450.93
Semaglutide 0.4 mg-15.150.92
Semaglutide 0.3 mg (Fast Escalation)-12.540.93
Semaglutide 0.4 mg (Fast Escalation)-17.360.92
Liraglutide 3.0 mg-8.470.93
Placebo Pool-2.480.82
Secondary outcomeLeast squares mean· Week 0, Week 52

Change in Waist Circumference

GroupValue (Centimetre (cm))Spread
Semaglutide 0.05 mg-6.110.93
Semaglutide 0.1 mg-8.750.90
Semaglutide 0.2 mg-11.020.89
Semaglutide 0.3 mg-10.910.89
Semaglutide 0.4 mg-12.310.91
Semaglutide 0.3 mg (Fast Escalation)-11.060.95
Semaglutide 0.4 mg (Fast Escalation)-14.880.88
Liraglutide 3.0 mg-8.350.89
Placebo Pool-3.470.81
Secondary outcomeLeast squares mean· Week 0, Week 52

Change in Waist to Hip Circumference Ratio

GroupValue (Waist to hip circumference ratio)Spread
Semaglutide 0.05 mg-0.010.01
Semaglutide 0.1 mg-0.020.01
Semaglutide 0.2 mg-0.020.01
Semaglutide 0.3 mg-0.030.01
Semaglutide 0.4 mg-0.020.01
Semaglutide 0.3 mg (Fast Escalation)-0.020.01
Semaglutide 0.4 mg (Fast Escalation)-0.030.01
Liraglutide 3.0 mg-0.020.01
Placebo Pool-0.010.00
Secondary outcomeLeast squares mean· Week 0, Week 52

Change in BMI

GroupValue (Kilogram per square meter (kg/m^2))Spread
Semaglutide 0.05 mg-2.370.33
Semaglutide 0.1 mg-3.360.33
Semaglutide 0.2 mg-4.380.33
Semaglutide 0.3 mg-4.400.33
Semaglutide 0.4 mg-5.400.33
Semaglutide 0.3 mg (Fast Escalation)-4.480.33
Semaglutide 0.4 mg (Fast Escalation)-6.210.33
Liraglutide 3.0 mg-3.030.33
Placebo Pool-0.880.29
Secondary outcomeLeast squares mean· Week 0, Week 52

Change in HbA1c

GroupValue (Percentage of HbA1c)Spread
Semaglutide 0.05 mg-0.130.03
Semaglutide 0.1 mg-0.210.03
Semaglutide 0.2 mg-0.280.03
Semaglutide 0.3 mg-0.230.03
Semaglutide 0.4 mg-0.290.03
Semaglutide 0.3 mg (Fast Escalation)-0.250.03
Semaglutide 0.4 mg (Fast Escalation)-0.340.03
Liraglutide 3.0 mg-0.210.03
Placebo Pool-0.010.03

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
Semaglutide 0.05 mgParticipants received once daily semaglutide 0.05 mg s.c. injections for 52 weeks.0 / 10313 / 10383 / 103
Semaglutide 0.1 mgParticipants received once daily semaglutide s.c. injections for 52 weeks. Dose escalation was done at every fourth week as following: 0.05 mg (week 1 to week 4) and 0.1 mg (week 5 to week 52).0 / 1028 / 10287 / 102
Semaglutide 0.2 mgParticipants received once daily semaglutide s.c. injections for 52 weeks. Dose escalation was done at every fourth week as following: 0.05 mg (week 1 to week 4), 0.1 mg (week 5 to week 8), and 0.2 mg (week 9 to week 52).0 / 1035 / 10384 / 103
Semaglutide 0.3 mgParticipants received once daily semaglutide s.c. injections for 52 weeks. Dose escalation was done at every fourth week as following: 0.05 mg (week 1 to week 4), 0.1 mg (week 5 to week 8), 0.2 mg (week 9 to week 12), and 0.3 mg (week 13 to week 52).0 / 1036 / 10385 / 103
Semaglutide 0.4 mgParticipants received once daily semaglutide s.c. injections for 52 weeks. Dose escalation was done at every fourth week as following: 0.05 mg (week 1 to week 4), 0.1 mg (week 5 to week 8), 0.2 mg (week 9 to week 12), 0.3 mg (week 13 to week 16), and 0.4 mg (week 17 to week 52).0 / 10213 / 10290 / 102
Semaglutide 0.3 mg (Fast Escalation)Participants received once daily semaglutide s.c. injections for 52 weeks. Dose escalation was done at every second week (fast escalation) as following: 0.05 mg (in weeks 1 and 2), 0.1 mg (in weeks 3 and 4), 0.2 mg (in weeks 5 and 6), and 0.3 mg (week 7 to week 52).0 / 1026 / 10291 / 102
Semaglutide 0.4 mg (Fast Escalation)Participants received once daily semaglutide s.c. injections for 52 weeks. Dose escalation was done at every second week (fast escalation) as following: 0.05 mg (in weeks 1 and 2), 0.1 mg (in weeks 3 and 4), 0.2 mg (in weeks 5 and 6), 0.3 mg (in weeks 7 and 8), and 0.4 mg (week 9 to week 52).1 / 1037 / 10388 / 103
Liraglutide 3.0 mgParticipants received once daily liraglutide s.c. injections for 52 weeks. Dose escalation was done at every week as following: 0.6 mg in week 1, 1.2 mg in week 2, 1.8 mg in week 3, 2.4 mg in week 4, and 3.0 mg from week 5 to week 52.0 / 1034 / 10383 / 103
Placebo PoolParticipants received once daily placebo s.c injections (matching each of the active treatment arms: semaglutide 0.05 mg, 0.1 mg, 0.2 mg, 0.3 mg or 0.4 mg (dose escalation every fourth week); semaglutide 0.3 mg or 0.4 mg (dose escalation every second week); liraglutide 3.0 mg (dose escalation every week)).0 / 13611 / 13687 / 136

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies2

Studies that cite this trial.

Studies with results

1 study on this page

Indexing hint: Randomized controlled trial · 2019

Validation of a new measure of quality of life in obesity trials: Impact of Weight on Quality of Life-Lite Clinical Trials Version.

Kolotkin et al. 2019Clinical obesitycited by 59

PMID 30993900PMC6593657DOI 10.1111/cob.12310PUB-30993900

Free to read · publisher termsCC BY-NC
Read at source

Indexing hint: Randomized controlled trial · 2018

10 results

Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial.

O'Neil et al. 2018Lancet (London, England)cited by 615

PMID 30122305DOI 10.1016/s0140-6736(18)31773-2PUB-30122305

Full text at the publisher10 results

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: - Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including activities to determine suitability for the trial - Male or female, age 18 years or older at the time of signing inform consent - Body mass index (BMI) equal or above 30.0 kg/m\^2 at the screening visit - At least one unsuccessful weight loss attempt per investigator judgement Exclusion Criteria: - A HbA1c (glycosylated haemoglobin) equal to or above 6.5% at screening or diagnosed with type 1 or type 2 diabetes mellitus - Treatment with glucose lowering agent(s) within 90 days before screening - Screening calcitonin equal to or above 50 ng/L (pg/mL) - Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 - History of pancreatitis (acute or chronic) - Obesity induced by endocrine disorders (e.g. Cushing Syndrome) - Treatment with any medication within 90 days before screening that based on investigator's judgement may cause significant weight change - Previous surgical treatment for obesity (liposuction and/or abdominoplasty performed 1 year before screening is allowed) - History of major depressive disorder within 2 years before randomisation - Any lifetime history of a suicidal attempt - Female who is pregnant, breast-feeding or intends to become pregnant or is of childbearing potential and not using an adequate contraceptive method (adequate contraceptive measures as required by local regulation or practice)

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