Relugolix combination therapy and symptoms of uterine myomatosis – selected case reports of indication spectrum and treatment outcomes
Authors:
R. Hudeček 1; J. Klát 2; K. Pohl 3; A. Prokopenko 4; L. Mikulášek 5; S. Šimová 1; P. Krčál 6; A. Ševčík 7; P. Tomeš 8
Authors‘ workplace:
Gynekologicko-porodnická klinika LF MU a FN Brno
1; Gynekologicko-porodnická klinika FN Ostrava
2; Gynekologická ambulance GYNPOHL s. r. o., Poliklinika ALTES, Kralupy nad Vltavou
3; Soukromá gynekologicko-porodnická ordinace, HEBEMED, Praha
4; Centrum Minimálně Invazivní Gynekologické Operativy (CMIGO), Reprodukční Medicíny (CRM), Endometriosy, Adenomyosy (CLEA) & Centrum Léčby Myomů (CLM), Praha
5; Gynekologie MU Dr. Krčál, s. r. o., Gynekologická ordinace Chlumčany, Chotěšov
6; Gynekologická ambulance, Jihlava
7; Ambulance pro léčbu myomatózy a endometriózy FN Plzeň
8
Published in:
Ceska Gynekol 2023; 88(5): 359-370
Category:
doi:
https://doi.org/10.48095/cccg2023359
Overview
Objective: An illustrative review of the indications for relugolix combination therapy (RCT) in the management of symptoms associated with uterine myomatosis. Methods: A set of annotated case reports from outpatient and clinical practice. Results: The file includes a non-invasive methodology for defining excessive menstrual bleeding using the pictorial bleeding assessment chart (PBAC). It also presents the use of RCT as a fertility-sparing procedure prior to elective myomectomy and the management of isthmic fibroids as an uterine factor of infertility. Cases of RCT of adenomyosis in primary sterility and in extragenital forms of endometriosis are commented. Emergent events associated with complications of myomatosis in pregnancy are represented by a case report of necrotizing diff use myomatosis in puerperium. The differential-diagnostic confusion of adnexal pathology and myomatosis, RCT as a final solution to failed pharmacotherapy, and the alternative of hysterectomy in premenopause illustrate the diverse spectrum of indications for pharmacological treatment, including the possibility of dual therapy with RCT and aGnRH. Conclusion: Relugolix combination therapy as an effective and safe causal treatment expands the therapeutic spectrum and options for reproductive medicine specialists and registering gynaecologists. The availability of conservative treatment in combination with surgical treatment leads to optimalization and greater effectiveness of therapeutic procedures and increased quality of life for women with myomatosis.
Keywords:
relugolix combination therapy – uterine fibroid symptoms
Sources
1. Bulun SE. Uterine fibroids. N Engl J Med 2013; 369 (14): 1344–1355. doi: 10.1056/NEJMra1209 993.
2. Stewart EA. Uterine fibroids. Lancet 2001; 357 (9252): 293–298. doi: 10.1016/S0140-6736 (00) 03622-9.
3. Zimmermann A, Bernuit D, Gerlinger C et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health 2012; 12: 6. doi: 10.1186/1472-6874-12-6.
4. Donnez J, Dolmans MM. Hormone therapy for intramural myoma-related infertility from ulipristal acetate to GnRH antagonist: a review. Reprod Biomed Online 2020; 41 (3): 431–442. doi: 10.1016/j.rbmo.2020.05.017.
5. Fuldeore MJ, Soliman AM. Patient-reported prevalence and symptomatic burden of uterine fibroids among women in the United States: findings from a cross-sectional survey analysis. Int J Womens Health 2017; 9: 403–411. doi: 10.2147/IJWH.S133212.
6. Cardozo ER, Clark AD, Banks NK et al. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol 2012; 206 (3): 211.e1–211.e9. doi: 10.1016/j.ajog.2011.12.002.
7. Stewart EA. Clinical practice. Uterine fibroids. N Engl J Med 2015; 372 (17): 1646–1655. doi: 10.1056/NEJMcp1411029.
8. Yao X, Stewart EA, Laughlin-Tommaso SK et al. Medical therapies for heavy menstrual bleeding in women with uterine fibroids: a retrospective analysis of a large commercially insured population in the USA. BJOG 2017; 124 (2): 322–330. doi: 10.1111/1471-0528.14383.
9. Gurusamy KS, Vaughan J, Fraser IS et al. Medical therapies for uterine fibroids – a systematic review and network meta-analysis of randomised controlled trials. PLoS One 2016; 11 (2): e0149631. doi: 10.1371/journal.pone.0149631.
10. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22 (6): 665–686. doi: 10.1093/humupd/dmw023.
11. Ng J, Chwalisz K, Carter DC et al. Dose-dependent suppression of gonadotropins and ovarian hormones by elagolix in healthy premenopausal women. J Clin Endocrinol Metab 2017; 102 (5): 1683–1691. doi: 10.1210/jc.2016-3845.
12. Taylor HS, Giudice LC, Lessey BA et al. Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. N Engl J Med 2017; 377 (1): 28–40. doi: 10.1056/NEJMoa1700089.
13. Carr BR, Marshburn PB, Weatherall PT et al. An evaluation of the effect of gonadotropin-releasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebo-controlled, crossover trial. J Clin Endocrinol Metab 1993; 76 (5): 1217–1223. doi: 10.1210/jcem.76.5.8496313.
14. Friedman AJ, Daly M, Juneau-Norcross M et al. Long-term medical therapy for leiomyomata uteri: a prospective, randomized study of leuprolide acetate depot plus either oestrogen-progestin or progestin ‘add-back’ for 2 years. Hum Reprod 1994; 9 (9): 1618–1625. doi: 10.1093/oxfordjournals.humrep.a138762.
15. Hornstein MD, Surrey ES, Weisberg GW et al. Leuprolide acetate depot and hormonal add-back in endometriosis: a 12-month study. Obstet Gynecol 1998; 91 (1): 16–24. doi: 10.1016/s0029-7844 (97) 00620-0.
16. Al-Hendy A, Lukes AS, Poindexter AN 3rd et al. Treatment of uterine fibroid symptoms with relugolix combination therapy. N Engl J Med 2021; 384 (7): 630–642. doi: 10.1056/NEJMoa2008283.
17. Al-Hendy A, Lukes AS, Poindexter AN 3rd et al. Long-term relugolix combination therapy for symptomatic uterine leiomyomas. Obstet Gynecol 2022; 140 (6): 920–930. doi: 10.1097/AOG.0000000000004988.
18. Al-Hendy A, Lukes AS, Poindexter AN 3rd et al. A plain language summary of the safety of relugolix combination therapy and improvement in symptoms in women with uterine fibroids from the LIBERTY 1 and LIBERTY 2 studies. Pain Manag 2023; 13 (4): 205–211. doi: 10.2217/pmt-2022-0085.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2023 Issue 5
Most read in this issue
- Early treatment of vulvar synechiae in childhood – prevention of late complications
- Relugolix combination therapy and symptoms of uterine myomatosis – selected case reports of indication spectrum and treatment outcomes
- Implementation of the ERAS protocol in gynecology and oncogynecology – evaluation of a pilot study
- Nascent myoma as a cause of urinary retention