Relugolix combination therapy for endometriosis pain

Abstract

The treatment of endometriosis-associated pain continues to be a major problem for women and their clinicians. 1 Dunselman GA Vermeulen N Becker C et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014; 29: 400-412 Crossref PubMed Scopus (1352) Google Scholar , 2 Nnoaham KE Hummelshoj L Webster P et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011; 96 (e8): 366-373 Summary Full Text Full Text PDF PubMed Scopus (732) Google Scholar Laparoscopy, required to confirm the diagnosis, is usually combined with surgical ablation or excision of endometriotic lesions to alleviate pain and hormonal contraceptives are used to control symptoms before and after the operation. 1 Dunselman GA Vermeulen N Becker C et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014; 29: 400-412 Crossref PubMed Scopus (1352) Google Scholar , 3 National Institute of Health and Care ExcellenceEndometriosis: diagnosis and management. https://www.nice.org.uk/guidance/ng73Date: Sept 6, 2017 Date accessed: March 31, 2022 Google Scholar Recurrence of pain is common, with 40–50% of women with endometriosis reporting recurrence within 5 years of treatment 4 Guo SW Recurrence of endometriosis and its control. Hum Reprod Update. 2009; 15: 441-461 Crossref PubMed Scopus (417) Google Scholar and nearly two-thirds of women requiring repeat surgery. 5 Saraswat L Ayansina D Cooper KG Bhattacharya S Horne AW Bhattacharya S Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG. 2018; 125: 64-72 Crossref PubMed Scopus (37) Google Scholar Gonadotrophin releasing hormone (GnRH) analogues (agonists and antagonists), which cause profound suppression of ovarian oestrogen production, are often used as second-line agents to control pain and reduce the need for further surgery, 6 Brown J Pan A Hart RJ Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010; 8CD008475 Crossref Google Scholar but they can lead to hypoestrogenic side-effects including hot flushes, night sweats, and loss of bone mineral density; these side effects can be addressed with the addition of hormone replacement therapy (HRT) without compromising treatment efficacy. 7 Barbieri RL Hormone treatment of endometriosis: the estrogen threshold hypothesis. Am J Obstet Gynecol. 1992; 166: 740-745 Summary Full Text PDF PubMed Scopus (276) Google Scholar , 8 Sagsveen M Farmer JE Prentice A Breeze A Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev. 2003; 4CD001297 Google Scholar Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2)Once-daily relugolix combination therapy significantly improved endometriosis-associated pain and was well tolerated. This oral therapy has the potential to address the unmet clinical need for long-term medical treatment for endometriosis, reducing the need for opioid use or repeated surgical treatment. Full-Text PDF Open Access