2172 Effect of GNRH Antagonist, Elagolix on Size and Quantity of Endometriotic Lesions Following 2 Months of Therapy

Abstract

Study Objective Data on the effect of GnRH antagonist, Elagolix on pathological lesions of endometriosis is lacking. We present a case where second look laparoscopy was done on a patient treated with Elagolix, where the effect of the drug on implants is described. Design Case report and review of the English literature. Setting Tertiary care hospital. Patients or Participants A 39-year-old female patient. Interventions A 39-year-old G3P2A1 female patient had long-standing history of dysmenorrhoea, deep pelvic pain, and dyspareunia controlled by oral contraceptives. She underwent laparoscopic bilateral tubal sterilization and multiple endometriotic implants were observed in the left uterosacral ligament, posterior cul-de-sac, and deep peritoneal pocket. Postoperatively the patient was started on Elagolix 150 mg daily. The patient's symptoms improved, however, she requested surgery as a definitive treatment for her endometriosis. Therefore, laparoscopic resection and ablation of endometriotic implants were done two months after initiation of therapy with Elagolix. Measurements and Main Results Following initiation of therapy with Elagolix, the patient reported a significant improvement in her symptoms and quality of life. On second look laparoscopy, a marked reduction in size and number of implants were observed. Histopathological evaluation of biopsy from a residual implant was consistent with endometriosis. Conclusion Endometriosis is a chronic gynecological condition which often produces debilitating pain and infertility. Elagolix is a novel drug, which has been recently approved in the US for treatment of moderate to severe endometriosis-related pain. In this case report, a marked reduction of disease was observed both symptomatically and on direct visualization of lesions. There have been previous studies demonstrating the effect of Leuprolide, Danazol and aromatase inhibitors on endometriotic implants. However, more information is required to provide evidence on the effect of Elagolix on the disease process, duration of pain-free interval and recurrence of disease after cessation of therapy.