Abstract
Background: Endometriosis commonly presents with dysmenorrhea, non-menstrual pelvic pain, and infertility. Elagolix is an oral, short-acting, gonadotropin-releasing hormone antagonist acting through complete estrogen suppression. Objective: To evaluate the evidence from published randomized controlled trials (RCTs) about the efficacy and safety of Elagolix in the treatment of endometriosis associated pain. Search strategy: Electronic databases containing articles published between January 2000 and February 2020 were searched using the MeSH terms (Elagolix OR gonadotropin-releasing hormone antagonist OR GnRH antagonist OR antigonadotropin) AND (endometriosis) AND (pelvic pain). Selection criteria: All RCTs assessing the efficacy of Elagolix in the treatment of pain associated with endometriosis were considered for this network meta-analysis, where five studies were deemed eligible for this review. Data collection and analysis: The mean difference (MD) and confidence intervals (95% CI) for continuous outcomes including analgesic use, dysmenorrhea, non-menstrual pelvic pain, and quality of life were calculated. Main results: Elagolix 250 mg reduced dysmenorrhea significantly, as compared to placebo, (MD = -0.41, 95% CI [-0.7, -0.13]) at 12 weeks, while Elagolix 200 mg reduced dysmenorrhea significantly (MD= -1.2, 95% CI [-1.9, -0.57]) compared to placebo after 24 weeks of treatment. Conclusions: Elagolix 200 mg seems to be an effective drug with fewer side effects when used to reduce dysmenorrhea and non-menstrual pelvic pain after 24 weeks of treatment in patients with endometriosis.
Highlights
Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus.[1,2] Ectopic tissue deposits are mainly found on the pelvic peritoneum, ovaries, and rectovaginal septum.[2]
Elagolix 200 mg seems to be an effective drug with fewer side effects when used to reduce dysmenorrhea and non-menstrual pelvic pain after 24 weeks of treatment in patients with endometriosis
We performed a comprehensive search in four electronic databases: PubMed, Scopus, Cochrane Library and International Scientific Indexing (ISI), using a combination of the following MeSH terms (Elagolix odds ratios (ORs) gonadotropinreleasing hormone antagonist OR GnRH antagonist OR antigonadotropin) AND AND, for articles published between January 2000 and February 2020
Summary
Endometriosis is characterized by the presence of endometrial-like tissue outside the uterus.[1,2] Ectopic tissue deposits are mainly found on the pelvic peritoneum, ovaries, and rectovaginal septum.[2]. The range of symptoms caused by endometriosis includes pelvic–abdominal pain, heavy menstrual bleeding, non-menstrual pelvic pain, pain at ovulation, dyschezia and dysuria.[6] Patients may suffer from chronic fatigue with deleterious effects on patients’ quality of life.[1]. The specifics of the pathophysiology of endometriosis are still a subject of controversy.[2] One explanation --“the estrogen threshold hypothesis” -- on which current medical treatments for endometriosis have been based, has shown favorable results as an alternative to surgery in selected cases.[7] Currently available medical therapies include non-steroidal anti-inflammatory drugs (NSAIDs), progestin-only oral contraceptives, combined hormonal contraceptives (CHCs), the 52mg Levonorgestrel-releasing intrauterine system and injectable gonadotropinreleasing hormone (GnRH) agonists.[8] the side effect profiles of these therapies still represent a gap in finding a treatment that better balances the favorable side of estrogen suppression with its unfavorable associated side effects (e.g., bone density loss, vasomotor symptoms).[8,9,10,11]. Short-acting, gonadotropin-releasing hormone antagonist acting through complete estrogen suppression
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